Secondary Electronic Claims Setup 7/17/2008

Carrier Setup

����������� 1. Version 7.0, The Co-Ins remark field in the Maintenance>>Insurance carrier ����������� screen should �� be PR2 on all carriers, including Medicare.

����������� 2. Version 6.5, under Carriers, the remark code field will not be available.� When �������� claim file is created, PR2 will automatically be inserted into the proper record.

����������� 3. Carrier type must be filled in�

����������� 4. Release of Information must be Y

���� Carrier ECS\ Other Tab

����������� 1. All carriers must have a payer id.

����������� If the carrier does not accept electronic claims, use NOCOD for claims sent to HCDS.

����������� If the carrier does not accept electronic claims, use 00000 for claims sent to ���� Mckesson on the ENSFP � ENSFPA � ENSF � ENSFA formats.

����������� 2. Bill Primary Only- Applies to electronic claims only.

����������� The �Bill Primary Only� box should be un-checked on those carriers that you ���� want the secondary claims to be sent electronically.

����������� �

Patient Coverage

Primary insurance�

����������� 1. Relationship to Medicare. This is the reason why the coverage is primary to ����� Medicare.

����������������������� -If the secondary insurance is Medicare, choose the selection that best ������������������������� �describes why the coverage is primary to Medicare

����������������������� -If the secondary insurance is Commercial, choose NONE.

����������������������� -If Medicare is primary then choose NONE.����

����������������������� -If there is one insurance, choose NONE.

����������������������� -If there is a commercial primary and commercial secondary, choose ��������������������������� ��NONE.

����������� 2. Policy Type

����������� ����������� - Choose the policy type for the Commercial carrier

����������� - If Medicare is primary, choose Medicare conditionally primary.

Secondary or Tertiary Insurance �

����������� 1. Relationship to Medicare = NONE for all Medicare and Commercial carriers

����������� 2. Policy Type

����������������������� - Choose the policy type for the Commercial carrier

����������������������� - Choose �Medicare conditionally primary� when Medicare is Secondary

Patient History Detail

����������� 1. The allowed amount must be entered when posting the primary insurance ����� payment.

����������� 2. Each line item must have a remark code entered in the Remark Code field after �������� the payment has been made.

����������� Examples of Remark codes:

����������������������� CO1 = Deductible

����������������������� CO2 = Coinsurance Amount

����������������������� CO3 = Co-payment

����������������������� CO45- Charges exceed your contracted/legislated fee ������������������������������������������������������������� arrangement

����������������������� CO51 �These services are non-covered because this is a pre-existing �������������������������� condition

����������� For a complete list of Remark codes go to www.wpc-edi.com

����������� Click on HIPAA Code Lists >>Claim Adjustment Reason Codes

Billing �Electronic Claims

����������� 1. Create a separate billing run for secondary claims.�

����������� 2.� Un-check primary plan and check the non-primary plan box���������

����������� 3.� Enter a low carrier code and high carrier code to only bill one carrier.

����������� If the low and � high carrier range is left blank, all carriers that are setup for ������ electronic claims that have charges that are ready to bill the secondary carrier will ������ reject if the patient coverage is not setup and the remark code is not entered on the ������ line item. To prevent this from happening, the Bill Primary Only field should ������ be un-checked on those carriers that you want the secondary claims to �� be sent electronically.