A few years ago Medicare Health Insurance began requesting medical offices to submit all Medicare Health Insurance claims electronically to save processing costs. In order to handle the connection of software products to Medicare they created a department called the Electronic Data Interchange or EDI.
The EDI department has the right to kick out a claim before it comes through their claim processing system. If a medical claim is kicked out at the EDI level it is like the insurance carrier never received the medical claim in the first place.
If you have issues where you are sending Medicare Health Insurance claims and they are not appearing in the IVR or in the support line it means one of two things:
1. Your clearinghouse kicked out the claim for issues
2. The Medicare EDI department kicked out the claim for issues
I would first recommend viewing your EDI reports for the patient that Medicare Support was not able to find on file. Now that you have the report read the exclusion reason...
If you don't understand the denial reason you have 3 different options depending on how you are submitting the claim:
1. If you use a Practice Management software that is integrated with the medical claims clearinghouse you might want to contact them first to see how to resolve the issue.
2. If you use a Practice Management Software that is not integrated with the medical claims clearinghouse and you can contact your medical claims clearinghouse do so now. Ask them to pull the file and see why they can identify the claim is getting kicked out.
3. If you have a direct connection with Medicare Health Insurance follow the EDI Hotline Rules
To make a phone call to the EDI Hotline please have this information handy:
1. Submitter ID number. It can also be called Sender ID, User ID and/or Billing Location Code for providers sending to Medicare Health Insurance through Blue Cross of Michigan.
2. NPI number (National Provider Identifier) and can be found in the NPPES directory
3. Date you submitted the claim
4. Processed Date if report states "deleted"
Do not call Medicare's EDI Hotline until you have prepared all of this information. They are usually very nice in the EDI department but they are in a hurry so they need this information quickly.EDI Hotline for Medicare Part Health Insurance Carriers: 877-567-7261
To read more about Medicare updates including Billing Health Insurance Information check out Medicare Medical Coding and Billing Courses
Medical Billing Insurance Tags: Medicare Health Insurance, Health Insurance Claims processing, Medical Claims Billing, Medical Health Insurance Claims, Electronic Claim Submission, EDI Hotline for Medicare Part B, How to fix denials for Medicare, Deleted Files on EDI Reports, How to work EDI Denial Reports, EDI Denial options, Medical Billing, Medical Billing and Coding, Medical Coding,