Wednesday, August 27, 2008

Clearinghouse Electronic Claim issue

I had a client email me a question needing to know how to handle a situation where she is billing claims electronically to RelayHealth which RelayHealth is dropping to paper and mailing to the insurance carrier. The Insurance carrier is notifying the client that the wrong format is being used - how does she fix this.

The carrier CPID#1360 (HCFA-1500 format) is setup incorrectly causing the claim to be billed to the wrong Claim Template which is causing the claim exclusions.

CARE IMPRVMNT PLUS OF TX CPID: 1360PA (should be billed as CPID 4300 CMS-1500 format)

Follow these steps:
1. Log into the office key
2. Click on Master Files > Carriers > Carriers
3. Pull up Insurance Carrier: Care Improvement Plus of TX
4. Change the CPID#1360 (HCFA 1500 format) to 4300 (CMS 1500 format)

Once the carrier has been fixed please rebill all claims

1. Billing > Insurance Billing > Rebill Claims
2. Enter this insurance carrier as high and low
3. Select a date range like current year
4. Click Next

After claims are rebilled re-submit them to McKesson
1. Click on Claims Submission Wizard
2. Enter insurance carrier as high and low
3. Click Next

Call the insurance carrier in about 10-15 business days to verify they are receiving the claims on the correct claim template.

**These steps are based on the AdvancedMD practice management software which is what the client uses. Please follow the steps specific to your PM software to fix and rebill claims.

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