[MT-L] MEDICARE 835 REMIT POSTING

[Mary Wagner]

We have an issue with our Medicare part B payments. On part B plans we do not want the contractual CO45 & CO97 to post but if we remove these from the claim map the contractual for Medicare part A will not post. MT indicates there is no way to restrict these by mnemonic. I tried excluding the adjustment code from the insurance dictionary and that caused the adjustment to default to the payment code which was worse.

MT can evaluate as a custom quotable. Any suggestions?

Thank you,
Mary Wagner
Applications Analyst, IT Dept

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[Julia Carter]

Are you using the same EDI program for Medicare A and B? Set up a separate one for B and create the new maps that you need for the contractuals. I've done it this way before for some of the same reasons.

Do your Medicare 835 files come separately? Mine did, so I was able to use MCRA and MCRB EDI programs and configure them each separately.

Julia

Julia Carter, CPAR
Senior Consultant
Consultant People
396 W Main St
Lewisville, TX 75057
http://www.cpeople.org
(229) 891-6668

[Mary Wagner]

Ours do not come separately. We have Emdeon, maybe they can separate these.

Thank you,
Mary

[Amber Adkins]

We built the MCR Remit twice in the remit dictionary - called them MCRUB
and MCRPF. Once that is done, you can remove the CO45 and CO97 from the
map listed on your part B remit, but leave it on your map for your part
A remit. Works like a charm :)

Amber Adkins

-----Original Message-----
From: meditech-...@mtusers.com
[mailto:meditech-...@mtusers.com] On Behalf Of Mary Wagner
Sent: Monday, August 16, 2010 1:25 PM
To: medit...@mtusers.com
Subject: [MT-L] MEDICARE 835 REMIT POSTING

[Smith Michael]

Hi Mary,

If you're only receiving one Medicare 835 for both part A and B you could have a custom on your hands.

I had to order a custom for a similar situation where the payer returned an 835 with both institutional and professional transactions. We wanted adjustments for professional charges to post, but not institutional since we're prorating that portion.

The way they solved this was by creating a new field that had an associated data list. The value in the data list is the claim program. It works by looking at the UCRN in the 835, then going back to the claim dictionary and checking the program used to create the claim. If the claim program is on the list the adjustment is suppressed. I don't see why the same principal couldn't be used in your situation.

HTH.

Michael D. Smith
Financial Analyst
Information Systems
Meadville Medical Center
764 Kennedy Street, Suite 301
Meadville, PA 16335
814.333.5251 Office
814.373.2155 Fax
msm...@mmchs.org
www.mmchs.org
 
You can not escape the responsibility of tomorrow by evading it today.
Abraham Lincoln
 
Information Systems Mission Statement: To provide consulting to executives, management and end-users for the effective implementation and use of computer systems at Meadville Medical Center.

Thank you,
Mary

Julia

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[Smith Michael]

Hi Amber,

We're a Magic 5.63 site, we won't be going to 5.64 till next summer.

And no, the our custom doesn't work with the CALC ADJ field. If you were to request a similar custom, you could certainly ask for that functionality.

Below are the custom specs edited slightly to include some changes my CL analyst and I hashed out.

And I hope you don't mind, but I'm posting this back to the L. Who knows, it might help someone else out.

CL #6509372 - 835 Adjustment by Institutional/Professional

The Problem
Meadville Medical Center wants to suppress adjustments for UCRNs that are
associated with UB based claims and allow adjustments to post for UCRNs
associated with 1500 based claims.

What is Being Done Now
Currently, either all adjustments post or no adjustments post. The site is
unable to specify for what type of claims Meadville Medical Center wants the
adjustments to post for.

The Solution
Custom coding will be delivered which will allow the site to suppress
adjustments for UCRNs that are associated with UB based claims.

UCRN's must be used on all outgoing claims that are returned and processed via
this remittance custom. This custom will not work with non-UCRN account numbers.

The Benefit
Meadville Medical Center will be able to suppress adjustments for UCRNs that are
associated with UB based claims.

The Input
Input will remain unchanged, 835 HIPAA remittance file uploaded into the
MEDITECH system.

The Process
The 835 remittance programming will be modified to allow the site to suppress
Adjustments for UCRNs that are associated with UB based claims.

This will require the use of UCRN's on all claims that are sent out and
remittances subsequently returned and uploaded into MEDITECH. The custom in
question will only work with UCRN account numbers, any other format will not
allow for the custom Adjustment suppression to take effect.

A new EDI field (UB/1500 MAP) will be provided in order to control this customization. The
field will contain a BAR map mnemonic. The BAR map will contain claim programs
for which adjustments should be suppressed on the left, mapped to a BAR list
mnemonic. The BAR list will contain insurances for which adjustments will be
suppressed. Therefore if a UCRN is for a claim program in the map AND an
insurance in the list, the adjustments for that UCRN will be suppressed.
Otherwise adjustments will post normally.

The Output
If the original claim type is UB (UB92-F, UB92-CPU, 837I, etc.), all adjustments
for that UCRN will be withheld from the remittance batch and rejection batch.

Routines Affected
835 remittance processing.

Additional Considerations
Please note that this custom programming modification has been evaluated and
coded based on the version of the software that existed at the time of delivery.
As you are updated to another version of the software, we will evaluate this
modification to determine if it can be retrofitted. During the review process,
should we find a significant changes in the programs that affect the
customization, thus rendering it not feasible to retrofit, then it will need to
be retired. You will be notified when/if this does occur.

Additionally, you will be notified prior to the delivery of your update if this
functionality is included in the standard product via an enhancement. In this
situation, we will not include the custom in the update in order to give you the
opportunity to review and test the standard functionality and confirm that it
will meet your needs. Once we receive your confirmation, we will retire this
custom.

Michael D. Smith
Financial Analyst
Information Systems
Meadville Medical Center
764 Kennedy Street, Suite 301
Meadville, PA 16335
814.333.5251 Office
814.373.2155 Fax
msm...@mmchs.org
www.mmchs.org
 

You cannot escape the responsibility of tomorrow by evading it today.

Abraham Lincoln
 
Information Systems Mission Statement: To provide consulting to executives, management and end-users for the effective implementation and use of computer systems at Meadville Medical Center.

-----Original Message-----
From: Crone, Amber [mailto:ACR...@shsny.com]
Sent: Tuesday, August 17, 2010 2:04 PM
To: Smith Michael
Subject: RE: [MT-L] MEDICARE 835 REMIT POSTING

Hi Michael,

I was reading your response and we seem to have the same issue with our other payers. I was hoping I could perhaps ask you a few questions as this may solve some big issues for us as well?

Are you client server or magic and are you 5.64 or higher? Would you mind sharing the name of the custom with us so that if we wanted to have something similar built we could reference your custom? Lastly do you know if this works with the CALC ADJ on the EDI program as well as the adjustment field?

Thank you for any info you can provide.

Amber Crone
Associate Analyst
Daily Operations
Samaritan Medical Center
(315) 785-5764