![Page 1: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/1.jpg)
Add TitleAdjusting a claim to add or remove other
insurance information
![Page 2: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/2.jpg)
Contents
Information needed prior to adjusting the paid claim
How to find other insurance information within CHAMPS
How to add other payer information to a paid claim
(pages 15-37)
How to add other payer denial information to a paid
claim (pages 38-53)
How to remove other payer information from a paid
claim (pages 54-64)
How to change or update existing other payer
information on a paid claim (pages 65-80)
How to add other payer information to an institutional
claim(pages 81-98)
![Page 3: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/3.jpg)
Information
Information needed prior to adjusting a claim with other
insurance
![Page 4: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/4.jpg)
Information cont. Turn off POP UP BLOCKERS within your internet settings
window.
Within the manage claims function, there is approximately 15 minutes available to complete an adjustment before the screen times out and locks the TCN for 24 hours. Ensure all necessary information for completing the adjustment is available prior to beginning an adjustment.
Claim Adjustment Reason Code (CARC) list and definitions found on the WPC website.
Prior to starting the claim adjustment, please have the following available: Primary payer Explanation of Benefits (EOB);
Verify the Payer ID within CHAMPS member eligibility screen; and
Verify the TCN is in a paid status and has been issued to a remittance advice (RA) or shows a pay cycle date within CHAMPS claim inquire.
![Page 5: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/5.jpg)
Member eligibility
Finding other insurance for a beneficiary within CHAMPS
![Page 6: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/6.jpg)
Open your web browser (e.g. Internet Explorer, Google Chrome, Mozilla Firefox, etc.)
Enter https://milogintp.Michigan.gov into the search bar
Enter your User ID and Password
Click Login
![Page 7: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/7.jpg)
You will be directed to your MILogin Home Page
Click the CHAMPS hyperlink
*MILogin resource links are listed at the bottom of the page
![Page 8: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/8.jpg)
Click Acknowledge/Agree to accept the Terms & Conditions to get into CHAMPS
![Page 9: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/9.jpg)
Select Domain
Choose the Domain(Billing NPI) and Profile from the dropdown menu
![Page 10: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/10.jpg)
Once logged into CHAMPS, select the Member tab
![Page 11: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/11.jpg)
Select Eligibility Inquiry
![Page 12: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/12.jpg)
Filter by Member ID and enter the 10 digit beneficiary ID number
Enter the inquiry start and end date
![Page 13: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/13.jpg)
Select the Commercial/Other hyperlink
![Page 14: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/14.jpg)
Take note of the Payer ID, Group number, and Policy number as this will be needed to
add the other insurance information to the claim
![Page 15: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/15.jpg)
How to add other payer
information to a paid claim
Adjusting a paid status claim to add other payer
payment or denial information
![Page 16: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/16.jpg)
How to add other payer information to a
paid claim cont.
When and why should a claim be adjusted to add
other payer information?
If the claim has been billed and paid by Medicaid
and you have been notified the beneficiary has a
primary payer
The pending Third Party Liability (TPL) void report
has been received and the primary payer has
already been billed but not reported on the claim
The following slides show an example of primary
payer information being added to a claim
![Page 17: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/17.jpg)
Once logged into CHAMPS, select the Claims tab
![Page 18: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/18.jpg)
Select Adjust/Void Claim Provider
![Page 19: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/19.jpg)
Enter the most current paid status TCN and select Go
The TCN must be the header TCN ending in 00
![Page 20: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/20.jpg)
From the Claim Header Detail page, select Other Payers Information from the show
dropdown menu
![Page 21: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/21.jpg)
Choose New Payer to add other payer information to the claim
![Page 22: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/22.jpg)
Select the Header TCN which ends in 00 from the dropdown
![Page 23: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/23.jpg)
Enter the Payer ID number which is found within the member eligibility screen
![Page 24: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/24.jpg)
Choose the Claim Filing Indicator from the dropdown, which will coincide with the
payer
![Page 25: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/25.jpg)
Enter the group and policy number which can be found within the member eligibility screen
Enter the amount paid for the entire claim by the other payer, if nothing paid enter $0.00
Choose the payer responsibility from the dropdown
Optionally enter the Remittance Advice (RA) date
Step 1 Step 2 Step 3 Step 4
![Page 26: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/26.jpg)
Select Add to add the other payer information to the claim
![Page 27: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/27.jpg)
After selecting Add, the other payers information will be added to the top of the other
payers box
Also note that the TCN number now begins with a 4, this is the new TCN number
![Page 28: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/28.jpg)
The other payer information will also need to be added to each service line
Select New Payer and the corresponding line TCN number ending in the service line
(01,02,03 etc.)
Choose Payer 1 from the Payer ID dropdown
![Page 29: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/29.jpg)
Enter the amount paid for the service line
Enter the amount that coincides with the Claim Adjustment Reason Code (CARC) you
are entering
Example shows $100.00 with CARC 45
Select Add
Step 1 Step 2 and 3
Step 4
![Page 30: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/30.jpg)
The line information will then be added to the top in the other payers information box
![Page 31: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/31.jpg)
Select from the payer dropdown box Existing Payer, as the payer has already been reported at the service line
Select the line TCN number and payer 1
Enter additional CARC and amounts based on the EOB
Select Add to add the additional CARC and amounts to the other payers information box at the top
Step 1 Step 2 Step 3 and 4
Step 5
![Page 32: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/32.jpg)
The CARC and amount will then be added to the top in the other payers information box
The total of other payer payments and CARC amounts for each service line must balance to the
submitted charges for the service line. If the information doesn’t balance providers will receive a
stack trace error message
![Page 33: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/33.jpg)
Other payer information must be reported for each service line billed on the claim
To add the other payer information for line #2, select new payer and line #2 from the TCN dropdown
Enter the CARC and amounts and select Add
Step 1 Step 2 Step 3 Step 4 Step 5
Step 6
![Page 34: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/34.jpg)
Once the payer information has been added for each service line, select Save
![Page 35: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/35.jpg)
Select Claim Header Detail from the Show select dropdown
![Page 36: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/36.jpg)
Make any other necessary changes to the claim
Select Save
Select Adjust
Step 1Step 2
![Page 37: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/37.jpg)
Select PIA-Provider Initiated ADJ from the Adjustment Source dropdown box
Enter a note as to why the claim is being adjusted
Select OK and your adjustment is complete and you will be returned to where you first entered your
paid TCN number
Step 1
Step 2
Step 3
![Page 38: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/38.jpg)
How to add other payer denial
information to a paid claim
Adding other payer denial information
![Page 39: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/39.jpg)
How to add other payer denial
information to a paid claim cont.
When and why should a claim be adjusted to add other payer denial information?
If the claim has been paid by Medicaid and the other payer denial information was not reported on the claim
The pending Third Party Liability (TPL) void report has been received and the primary payer has already been billed but not reported on the claim
If claim was originally billed to Medicaid and has been voided by TPL and the primary payer has already been billed
The following slides show an example claim with primary payer denial information being added to a claim
![Page 40: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/40.jpg)
Once logged into CHAMPS, select the Claims tab
![Page 41: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/41.jpg)
Select Adjust/Void Claim Provider
![Page 42: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/42.jpg)
Enter the most current paid status TCN and select Go
The TCN must be the header TCN ending in 00
![Page 43: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/43.jpg)
From the Claim Header Detail page, select from the Show dropdown menu Other
Payers Information
![Page 44: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/44.jpg)
Currently there is no other payer information reported as the claim was billed as
Medicaid primary
Choose New Payer to add other payer information to the claim
![Page 45: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/45.jpg)
Select the Header TCN which ends in 00 from the dropdown
![Page 46: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/46.jpg)
Enter the Payer ID number which is found within the member eligibility screen
![Page 47: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/47.jpg)
Choose the Claim Filing Indicator from the dropdown, which will coincide with the
payer
![Page 48: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/48.jpg)
Enter the group and policy number which can be found within the member eligibility screen
In this example, the other payer made no payment on the claim as the service was denied so $0.00 was reported
Choose the payer responsibility from the dropdown
Optionally enter the Remittance Advice (RA) date
Step 1 Step 2 Step 3 Step 4 Step 5
Step 6
![Page 49: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/49.jpg)
Add the other payer denial information for the service line
Enter the amount paid on the line and the appropriate CARC based on the EOB denial
Select Add to add the other payer information to the service line
Also note that the TCN number now begins with a 4, this is the new TCN number
Step 1 Step 2 Step 3 Step 4 Step 5 and 6
Step 7
![Page 50: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/50.jpg)
Once the other payer information has been added for each service line, select Save
![Page 51: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/51.jpg)
Choose Claim Header Detail from the Show select dropdown
![Page 52: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/52.jpg)
Make any other necessary changes to the claim
Select Save
Select Adjust
Step 1Step 2
![Page 53: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/53.jpg)
Select PIA-Provider Initiated AdJ from the Adjustment Source dropdown
Enter a note as to why the claim is being adjusted
Select OK and your adjustment is complete and you will be returned to where you first entered your
paid TCN number
Step 1
Step 2
Step 3
![Page 54: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/54.jpg)
How to remove other insurance
information from a paid claim
Removing primary insurance from a paid claim
![Page 55: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/55.jpg)
How to remove other insurance
information from a paid claim cont.
When and why should a claim be adjusted to
remove or delete other payer information?
If the primary payer has adjusted their clam and
recouped their entire payment
If the beneficiary does not have the primary payer
which was reported on the claim or the policy was
not active on the claim date of service
The following slides show an example of a claim
billed with a primary payer that will be deleted
from the claim
![Page 56: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/56.jpg)
Once logged into CHAMPS, select the Claims tab
![Page 57: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/57.jpg)
Select Adjust/Void Claim Provider
![Page 58: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/58.jpg)
Enter the most current paid status TCN and Select Go
The TCN must be the header TCN ending in 00
![Page 59: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/59.jpg)
From the Claim Header Detail page, select from the Show dropdown menu Other
Payers Information
![Page 60: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/60.jpg)
Select the check box above the payer information
![Page 61: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/61.jpg)
Select delete
Click OK to the pop-up message to remove the other payer information from the claim
Step 1
Step 2
![Page 62: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/62.jpg)
Choose Claim Header Detail from the Show select dropdown
Also note that the TCN number now begins with a 4, this is the new TCN number
![Page 63: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/63.jpg)
Make any other necessary changes to the claim at this time
Select Save
Select Adjust
Step 1Step 2
![Page 64: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/64.jpg)
Select PIA-Provider Initiated AdJ from the Adjustment Source dropdown
Enter a note as to why the claim is being adjusted
Select OK and your adjustment is complete and you will be returned to where you first entered your
paid TCN number
Step 1
Step 2
Step 3
![Page 65: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/65.jpg)
How to change or update existing
other insurance on a paid claim
Editing existing other payer information on a paid claim
![Page 66: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/66.jpg)
How to change or update existing other
insurance on a paid claim cont.
When and why should a claim be adjusted to edit existing other payer information? If the other payers information was reported
incorrectly in error according to the EOB
If the other payer has adjusted their claim and their payment information has changed
If the beneficiary has a secondary payer which was not reported on the paid claim as the provider was notified after the claim processed
The following slides show an example of how to add a secondary payer to a claim that has been billed reporting Medicare as primary
![Page 67: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/67.jpg)
Once logged into CHAMPS, select the Claims tab
![Page 68: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/68.jpg)
Select Adjust/Void Claim Provider
![Page 69: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/69.jpg)
Enter the most current paid status TCN and Select Go
The TCN must be the header TCN ending in 00
![Page 70: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/70.jpg)
From the Claim Header Detail page, select from the Show dropdown menu Other
Payers Information
![Page 71: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/71.jpg)
The current other payer information reflects Medicare was reported as the primary
payer
The beneficiary also has a secondary BCBS policy which would need to be reported
![Page 72: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/72.jpg)
Select New Payer
Select the Header TCN which ends in 00 from the dropdown
Step 1 Step 2
![Page 73: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/73.jpg)
Enter the payer ID, group and policy number which can be found within the member eligibility screen
Enter the amount paid for the entire claim by the other payer, if nothing paid enter $0.00
Choose the payer responsibility from the dropdown
Optionally enter the Remittance Advice (RA) date
Step 3 Step 4 Step 5 Step 6 Step 7 Step 8Step 9
![Page 74: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/74.jpg)
After selecting Add, the secondary other payers information will be added to the other
payers box
Also note that the TCN number now begins with a 4, this is the new TCN number
![Page 75: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/75.jpg)
The secondary other payer information will then need to be added to each service line
Select New Payer and the corresponding line TCN number ending in the service line (01,02,03
etc.)
Choose Payer 2 from the Payer ID dropdown
Step 1 Step 2 Step 3
![Page 76: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/76.jpg)
Enter the amount paid for the service line
Enter the amount that coincides with the Claim Adjustment Reason Code (CARC) being entered
Select Add
Step 4 Step 5 and
6
Step 7
![Page 77: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/77.jpg)
Continue adding the secondary payer information for each service line on the claim
Once complete, select Save
![Page 78: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/78.jpg)
Select Claim Header Detail from the Show select dropdown
![Page 79: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/79.jpg)
Make any other necessary changes to the claim at this time
Select Save
Select Adjust
Step 1Step 2
![Page 80: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/80.jpg)
Select PIA-Provider Initiated AdJ from the Adjustment Source dropdown
Enter a note as to why the claim is being adjusted
Select OK and your adjustment is complete and you will be returned to where you first entered your
paid TCN number
Step 1
Step 2
Step 3
![Page 81: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/81.jpg)
How to add other payer information
to an institutional claim
Adjusting a paid institutional claim to add the other
payer information
![Page 82: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/82.jpg)
How to add other payer information to an
institutional claim cont.
When and why should a claim be adjusted to add
the other payer information?
The pending Third Party Liability (TPL) void report
has been received and the primary payer has
already been billed but not reported on the claim
If claim was originally billed to Medicaid and has
been voided by TPL and the primary payer has
already been billed
The following slides show an example of how to
adjust an institutional claim adding the other payer
information at the header level
![Page 83: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/83.jpg)
Once logged into CHAMPS, select the Claims tab
![Page 84: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/84.jpg)
Select Adjust/Void Claim Provider
![Page 85: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/85.jpg)
Enter the most current paid status TCN and Select Go
The TCN must be the header TCN ending in 00
![Page 86: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/86.jpg)
From the Claim Header Detail page, select from the show dropdown menu Other
Payers Information
![Page 87: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/87.jpg)
Choose New Payer
Select the Header TCN which ends in 00 from the TCN dropdown
Step 1 Step 2
![Page 88: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/88.jpg)
Enter the payer ID which can be found within the member eligibility screen
Choose the Claim Filing Indicator from the dropdown, which will coincide with the
payer
Step 3
Step 4
![Page 89: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/89.jpg)
Enter the group and policy number which can be found within the member eligibility screen
Enter the amount paid for the entire claim by the other payer, if nothing paid enter $0.00
Choose the payer responsibility from the dropdown
Optionally enter the Remittance Advice (RA) date
Step 5 Step 6 Step 7
Step 8
![Page 90: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/90.jpg)
Enter the amount and reason code
Enter the amount that coincides with the Claim Adjustment Reason Code (CARC) being entered
Select Add
Step 9 and 10
Step 11
![Page 91: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/91.jpg)
After selecting Add, the other payer information will be added to the other payers box at the top
Also note that the TCN number now begins with a 4, this is the new TCN number
To add additional amounts and CARC ‘s to the claim, select existing payer
![Page 92: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/92.jpg)
Select the header TCN which ends in 00 from the TCN dropdown
![Page 93: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/93.jpg)
Select Payer 1 from the Payer ID dropdown
![Page 94: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/94.jpg)
Enter the amount associated with the CARC being reported
Select Add
![Page 95: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/95.jpg)
After selecting Add, the additional amount and CARC will be added to the Other Payers box at the
top
Continue adding additional amounts and CARC’s as necessary based on the other payer EOB
Once all amounts and CARC’s have been added, select Save
![Page 96: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/96.jpg)
Once all other payer information has been added to the claim, select Claim Header
Detail from the Show dropdown
![Page 97: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/97.jpg)
Make any other necessary changes to the claim
Select Save
Select Adjust
Step 1Step 2
![Page 98: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/98.jpg)
Select PIA-Provider Initiated AdJ from the Adjustment Source dropdown
Enter a note as to why the claim is being adjusted
Select OK and your adjustment is complete and you will be returned to where you first entered your
paid TCN number
Step 1
Step 2
Step 3
![Page 99: Adjusting a claim to add or remove other Add Title ... · Select Add to add the additional CARC and amounts to the other payers information box at the top Step 1 Step 2 Step 3 and](https://reader030.vdocument.in/reader030/viewer/2022021801/5b2ed5117f8b9af0648d1f55/html5/thumbnails/99.jpg)
Provider Resources
Medicaid Provider Training One on One trainings requests
Association requests Current trainings available
Michigan Medicaid List Serve
E-mail notification alerts relative to the Michigan Medicaid Program, including specific alerts for changes to Medicaid
policy, billing issues, training opportunities, etc.
Provider Support www.michigan.gov/medicaidproviders
[email protected] 1-800-292-2550
Thank you for participating in the Michigan Medicaid Program.