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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
Cabinet for Health and Family Services3
Representative List
Cabinet for Health and Family Services4
Representative List
Cabinet for Health and Family Services5
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
Cabinet for Health and Family Services6
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.
Cabinet for Health and Family Services7
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.
Cabinet for Health and Family Services8
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
Cabinet for Health and Family Services9
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
Cabinet for Health and Family Services10
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.
Cabinet for Health and Family Services11
UB 04 Top Half
Cabinet for Health and Family Services12
UB 04 Bottom Half
Cabinet for Health and Family Services13
Medicare EOB
Cabinet for Health and Family Services14
UB04 Top Half (Blank)
Cabinet for Health and Family Services15
UB04 Bottom Half (Blank)
Cabinet for Health and Family Services16
Medicare EOB
Cabinet for Health and Family Services17
UB04 Top Half (Blank)
Cabinet for Health and Family Services18
UB04 Bottom Half (Blank)
Cabinet for Health and Family Services19
Medicare EOB
Cabinet for Health and Family Services20
UB04 Header with Medicare #1
Cabinet for Health and Family Services21
UB04 Header with Medicare #2
Cabinet for Health and Family Services22
UB04 Deductible for Medicare
Cabinet for Health and Family Services23
Co-Insurance for Medicare
Cabinet for Health and Family Services24
Summary with Medicare (Top)
Cabinet for Health and Family Services25
Summary with Medicare (Bottom)