Information on Swine Flu

For the most current information about swine flu, visit the Centers for Disease Control and Prevention (CDC) website at: http://www.cdc.gov/swineflu. You will find consumer and provider fact sheets, current information, and steps you can take to protect yourself against infection.

At the CDC site, you will also be able to download a widget that you can post to your own website to help your patients get the most current and accurate information.

 

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RelayHealth Notify: Claims: Multiple CPIDs: New Claims Connections

The following new CPID(s) have been added for electronic claim submission using the 4010A1 ANSI format.  Effective immediately, claims can be submitted as follows.

 

CPID	Payor Name	Transaction Type	Enrollments
2102	Network Platinum Plus Premier	Professional	No
4880	Assurecare of Minnesota	Professional	No

 

RelayHealth Notify: Claims: CPIDs 7476, 7477, 7475 and 7478 DME All Jurisdictions: Claim Rejections

DME All Jurisdictions

 

 Action Required:  Please be aware of the following announcement from all DME Jurisdictions regarding possible claim rejections.

Edit C172 Issue on Claims with KE Modifier

 

An issue existed where edit C172 was being received in error on some service lines containing modifier KE for dates of service on or after January 1, 2009. This issue has been resolved and claims with the KE modifier should no longer receive this edit in error when submitted to CEDI.

This fix only affects claims submitted with the KE modifier for dates of service on or after January 1, 2009. If you feel you received this edit in error for claims previously submitted with the KE modifier, those claims may now be resubmitted to CEDI.

 

If you continue to receive CEDI edit C172, please contact the appropriate DME MAC to determine if you are submitting the correct HCPCS and/or modifiers.

 

Claims: CPID 4878 Health Choice Generations: New Claims Connection

The following new CPID(s) have been added for electronic claim submission using the 4010A1 ANSI format.  Effective immediately, claims can be submitted as follows.

 

CPID	Payor Name	Claim Type	Enrollments
4878	Health Choice Generations	Professional	No

 

RelayHealth Notify: Claims: CPID 3510 California Medi-Cal: Claim processing

 .  Please read the following bulletin from CPID 3510 California Medi-Cal.

 Action Required:  Please be aware of the following announcement from California Medi-cal regarding claims processing.

 

Billing More than 99 Units Requires Two Claim Lines

Providers are reminded that claims billed for more than 99 units must be billed on two or more claim lines, with no more than 99 units per claim line. If more than 99 units are billed, providers should use a second claim line (or more) to complete their billing. Claims billed with more than 99 units on a single line will be denied with Remittance Advice Details (RAD) code 9907: The quantity per claim line cannot exceed 99 units. For more information, providers should refer to the UB-04 Completion: Outpatient Services section in the appropriate Part 2 manual.

 

Topic: I have many claims that need organizing and updating, i'm confused (From Mike)

Dear RxDME2000 Hme software user,

 

There is an update to our Rxdme2000 Export/Purge program.  You probably didn't even know you had this program!   We have added a feature several clients have asked for - build a spreadsheet file, so you can manipulate your own data.

 

I suggest you first review the article explaining the update check out "I have many claims that need organizing and updating, I'm confused" on DMEFree & Simpleclaims Support Forum   .  To view it, please click this link:

http://www.dmefree.com/supportforum/index.php?topic=50.0

Thank you and enjoy

 

Mike

DMEFree / PCSolutions

Topic: I have many claims that need organizing and updating, i'm confused (From Mike)

We have updated the Import/Export/Purge Module for Rxdme2,
to get the update click this link

http://www.dmefreeserver.com/files/export217c.exe

this was in response to a client request as follows

In many businesses there are claims with unknow dispositions, was it billed, was it paid, did we rebill it after denial etc.
You can use the reconcile system to identify what is out standing,, but what about other issues with claims.

The new function in Export module is the ability to export claim records from the Transaction History file to a spreadsheet file. Why do we want this file if we use reconcile? Becuase you may want a print out of everythng for a large range of dates,, and work the claims thru payment, ie
use the spreadsheet to mark, when it's submitted, when paid, when denied , etc. Kind of like a worksheet to give you the confidence to know what the status of your claims are..


What happens,,,
The transaction history function on the Reports menu of Rxdme2 allows you to build a database of All claims for a range of dates, then sort this set of claims and search through it for reports and more. What makes transaction history so great is , it takes the 1500 form and recreates the claims in a separate file where all lines of the 1500 form are broken down or separted into their own claims. whereas rxdme2 holds upto 6 line items in one claim. This breakdown allows you to search right down to the individual procedure code.

Here is an example;
In transaction history menu we start by clearing the Transaction history file
then we build the transaction history for a range of dates, lets use 01/01/2008 thru 12/31/2009.
We now have the file built, we can use the View transaction history to see what claims are in this range.

We leave the Transaction history menu and go to Utitlies menu and Export menu.
Once in the Export program, we select Export - Transaction history
Now we can click the Step 1 button to search for just the date range or procedure code or insurance plan we want.
Once the claims are selected we can go to Step 2 to view them
Then Step 3 to export the data to a spreadsheet file.

You pick the fields to export, arrange their order and complete the export.
You then find the fle you created , click on it and Excel should open.

Now you have a spreadsheet you can sort, add columns and generally manipulate.

Claims: CPID 2112 Value Options and CPID 5941 ENTRUST: New Claims Connections

The following new CPID(s) have been added for electronic claim submission using the 4010A1 ANSI format. 

 

Effective immediately, claims can be submitted as follows.

 

CPID Payor Name Transaction Type Enrollments

2112 Value Options Professional No

5941 ENTRUST Institutional No

 

CPID

 

FOR COMMERCIAL PLANS

First you need to create or modify the plan in the insurance file.

 

You will need the CPID number which is found at

 

http://dmefree.com/plans_we_bill1.htm

 

You put this CPID # into the plan as follows;

 

in the Change or Add mode in the INSURANCE PLAN click PLAN

DATA TAB

Leave Provider# field blank unless instructed to enter a provider#

 

Put the CPID# into the 2nd field labed: GRPNO:

Set the PLAN TYPE to COMMERCIAL

 

 

 

from mike

The following new CPID(s) have been added for electronic claim submission using the 4010A1 ANSI format.  Effective immediately, claims can be submitted as follows.

 

CPID 4879

 

Molina Healthcare of Florida

 

Professional

 

 

Thank you

 

Mike Feldman

PCSolutions

www.dmefree.com

fax 860 974 1886