[MT-L] BAR 837 Secondary Claims

[Gary Ring]

Is anyone successfully generating 837 claims out of MEDITECH for secondary payers on a large-scale basis? 

At some of my clients, we're doing it on a very limited basis for 2 payers (Medicare, and the Massachusetts Health Safetey Net) because they require it!  And even then, it's only really been successful when you are assured that your primary payer adjudicated with an 835 in MEDITECH so that all of the COB and CAS segments can be generated.  It took us a long, long time to work out the COB details with MEDITECH for these payers, and I'm not even sure that all other payers have the same requirements (outside of the basic 837 COB requirements).

So I'm interested in hearing success stories, or horror stories, and even comments if you ARE NOT doing 837 secondary billing, and why.

Thanks.

Gary J. Ring
President
Ring Consulting, Inc.
11 Jones Road
Peabody, MA 01960
978-807-1573

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[Amber Adkins]

Hi Gary,

We are not currently doing this on a large scale, but just received our 5010 code and MT has some much better functionality in that program to allow for adding/editing the 835 COB info in order to facilitate this process. We will plan to in the near future with 5010 :)

Amber Adkins

[Ham, Gene (DMH)]

Hi Gary,

We are C/S 5.4 and generate secondary 837 claims. The challenges starts
with having Meditech make available the required fields to report
primary insurance information on the secondary claims ( CAS, SVD, AMT
DTP segments, etc. ). This further complicated because payer and
situation requirements vary as to what and where the primary
adjudication should be reported.

I know of only two ways to report the primary insurance adjudication
information on the secondary claim:

- use of the claim editing functionality to add the required COB data (
for us that works )

- import the primary insurance's 835 remit. This does not work for some
unknown reason though that is the preferred method as stated by
Meditech.

My principal issue is that I setup the Commercial (primary) insurance
not to adjust upon import of the 837 so that the money less the payment
would drop to the secondary payer (insurance). I am not clear of any
other way to insure that the adjusted amount drops as not adjusted off
on the bill.

Hope that helps. If you want any documentation we have put together just
let me know.

Gene

Phones: 617-626-8200 ( DMH central office, Boston ) 508-616-6063 (
Westboro State Hospital )

Fax: 617-626-8225

Beeper: 800-442-0354

EMAIL: gene...@DMH.state.ma.us

Confidentiality Notice: Protected Health Information from the
Massachusetts Department of Mental Health

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[Gary Ring]

One of the reasons it might not work, as I am just finding out with Magic clients, is that MEDITECH has this funky notion that it can't hook up or relate 835 information to an account that generated a paper claim; it only works when the primary payer's claim is an 837.  Don't ask me why, but they confirmed that's how it's working, and I've also confirmed it.  And I don't even know the problem is with the 835 posting, or with the generation of the secondary 837; and no one has been able to verify that for me either.  But our 837 secondaries generate all of the correct CAS, SVD, AMT, and DTP segments when everything is electronic; we only seem to have a problem if our primary payer's claim was not an 837.

We also had problems where, if a claim DENIED, they weren't recognizing that as being adjudicated, and didn't initially create the DTP and CAS segments.  But that problem has been fixed.

I'm working with them now to update their logic so that it will work even if the prior payer's claim was a UB04 and 1500 vs. an 837 transaction.  So I'll update the L when this has been accomplished and working.

Gary J. Ring
President
Ring Consulting, Inc.
11 Jones Road
Peabody, MA 01960
978-807-1573

----- Original Message -----
From: "Gene Ham (DMH)" <Gene...@state.ma.us>
To: garyr...@comcast.net
Cc: medit...@mtusers.com
Sent: Friday, July 23, 2010 12:55:13 PM
Subject: BAR 837 Secondary Claims

Hi Gary,

We are C/S 5.4 and generate secondary 837 claims. The challenges starts with having Meditech make available the required fields to report primary insurance information on the secondary claims ( CAS, SVD, AMT DTP segments, etc. ). This further complicated because payer and situation requirements vary as to what and where the primary adjudication should be reported.

I know of only two ways to report the primary insurance adjudication information on the secondary claim:

-  use of the claim editing functionality to add the required COB data ( for us that works )

-  import the primary insurance’s 835 remit. This does not work for some unknown reason though that is the preferred method as stated by Meditech.

My principal issue is that I setup the Commercial (primary) insurance not to adjust upon import of the 837 so that the money less the payment would drop to the secondary payer (insurance). I am not clear of any other way to insure that the adjusted amount drops as not adjusted off on the bill.

Hope that helps. If you want any documentation we have put together just let me know.

Gene

Phones: 617-626-8200  ( DMH central office, Boston  )  508-616-6063  ( Westboro State Hospital  )

Fax: 617-626-8225

Beeper: 800-442-0354

EMAIL: gene...@DMH.state.ma.us

Confidentiality Notice:  Protected Health Information from the Massachusetts Department of Mental Health

Protected Health Information is personal and sensitive information related to a person’s health care.  It is being e-mailed to you after appropriate authorization from the person or under circumstances that do not require the person’s authorization.

If you are not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, the disclosure, copying or distribution of this information is Strictly Prohibited .  If you have received this message by error, please notify the sender immediately.

[Smith Michael]

Hi Amber,

You say you just received your 5010 code? Do you mean via a PP, or version update? Inquiring minds want to know!

Thanks for the clarification. :-)


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.

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[Amber Adkins]

Hi Michael,

We just upgraded to 5.64 (Magic), which includes the ICD10 and 5010 programming. There are some really slick new routines with the 5010 remits and claims to both hand key and hand edit the primary payment information in the batch if needed, as well as hand add/edit at the account level prior to secondary claims submission.

[Smith Michael]

Ok, I was wondering.

A few months back when I asked my CL Analyst he said there would be a patch in a PP update. Of course he didn't say when. :-P So when I saw your post I thought maybe this was it.

I guess I'll have to ask him again.

Thanks for the info!

[Smith Michael]

Clarification: PP = Priority Pack (or whatever it's called), not Payroll Personnel

[Gammell, Yvonne M.]

Most IT vendors have a hard time with "unsolicited" 835s.

Those are electronic remit payments received from any source where an 837 was not sent out.

Personally, I think it is crazy too, but I know that that is an issue for a number of vendors so my guess is that when they wrote the code to store data from an 837 so that 835s could link up when they are later received, the routines that process in the 835 must be looking for info in fields within the DB that are only populated when a 837 is generated.

Could they get around this? Sure. But they'd need to rewrite the standard processing routines and most vendors won't do that just because you ask. The only time I saw it done, the client was a huge organization and represented significant value to the vendor.

Thanks! :-)

Yvonne M. Gammell
Central Vermont Medical Center
Analyst

130 Fisher Road, Berlin, VT 05602
yvonne....@cvmc.org
www.cvmc.org

Thanks! ☺

ymg

-----Original Message-----
From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com] On Behalf Of Gary Ring
Sent: Friday, July 23, 2010 1:27 PM
To: Gene Ham (DMH)
Cc: medit...@mtusers.com
Subject: Re: [MT-L] BAR 837 Secondary Claims

One of the reasons it might not work, as I am just finding out with Magic clients, is that MEDITECH has this funky notion that it can't hook up or relate 835 information to an account that generated a paper claim; it only works when the primary payer's claim is an 837.  Don't ask me why, but they confirmed that's how it's working, and I've also confirmed it. 

[Ham, Gene (DMH)]

Hi Yvonne,

Thanks for your response.
Note that our payer mix, across 55 provider sites looks roughly like this -

Medicaid circa 100% to 85%
Medicare 0% to 14%
Commercial 0% to 15%


This helps to clarify how we will proceed:

1. for Medicaid and Medicare we will claim and post remits electronically
2. for commercials we will claim on paper? and rely on the claim editor to comply with COB segments on secondary claims. ( to minimize manual processing )

That is, if the correct segments from the primary insurance can appear on the secondary claim. We are still testing with Meditech. ( currently only the 2330B DTP 'COB' segment is appearing on the secondary claim.

I appreciate any other thoughts folks may have.

Take Care, Gene

Phones: 617-626-8200  ( DMH central office, Boston  ) 508-616-6063  ( Westboro State Hospital  )
Fax: 617-626-8225
Beeper: 800-442-0354
EMAIL: gene...@DMH.state.ma.us

Confidentiality Notice: Protected Health Information from the Massachusetts Department of Mental Health

Protected Health Information is personal and sensitive information related to a person’s health care. It is being e-mailed to you after appropriate authorization from the person or under circumstances that do not require the person’s authorization.

If you are not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, the disclosure, copying or distribution of this information is Strictly Prohibited. If you have received this message by error, please notify the sender immediately.

Important Warning: This message is intended only for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law.

[Gammell, Yvonne M.]

We are doing this right now as well.

We were having a problem generating 2320-AMT segments because the T3 qualifier was missing from our 837I spec.

Meditech is loading it for us early next week and we will resume our testing of MSP claims at that point.

We will be using the claims editing function to "fix" claims where the primary payments were not electronically received as well.

I was hoping to use our interface engine to generate a secondary 837, but I haven’t the time right now to create that whole process. Extracting the data from Meditech and then filing the data as if the primary payment was electronically processed would hopefully avoid us having to manually touch secondary claims on the way out the door.

Thanks! :-)

Yvonne M. Gammell
Central Vermont Medical Center
Analyst

www.cvmc.org