kyhealth choices ub04 medicaid crossover workshop

KyHealth Choices

UB04 Medicaid Crossover Workshop

Cabinet for Health and Family Services2

Agenda

• Representative List • Reference List• 837 Requirements• Medicare EOB examples• Helpful Hints• How to Bill Medicare Primary Claims to

KyHealth Choices• Evaluation


Representative List


Reference List

Helpful Phone Numbers

EDI Helpdesk [email protected]

Provider Billing Inquiry [email protected]

Web Addresses

EDS Website www.kymmis.com

KyHealthnethttp://home.kymmis.com

KyHealth Choiceswww.chfs.ky.gov/dms


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.


UB 04 Top Half


UB 04 Bottom Half


Medicare EOB


UB04 Top Half (Blank)


UB04 Bottom Half (Blank)


Medicare EOB


UB04 Top Half (Blank)


UB04 Bottom Half (Blank)


Medicare EOB


UB04 Header with Medicare #1


UB04 Header with Medicare #2


UB04 Deductible for Medicare


Co-Insurance for Medicare


Summary with Medicare (Top)


Summary with Medicare (Bottom)

kyhealth choices ub04 medicaid crossover workshop

Documents

medicare slide

family services

medicare eob slide

half slide

medicare deductible

medicare eobs

half blank slide

representative list