DME MAC Dubuque and Chicago changes happening on EDI Reports

RelayHealth has received notification of changes to the reports received from the following CPIDs:

Dubuque
7475 Medicare DME MAC Jurisdiction A
7476 Medicare DME MAC Jurisdiction B
7477 Medicare DME MAC Jurisdiction C
7478 Medicare DME MAC Jurisdiction D

Chicago
4229 Medicare DME MAC Jurisdiction A
4230 Medicare DME MAC Jurisdiction B
4231 Medicare DME MAC Jurisdiction C
4232 Medicare DME MAC Jurisdiction D

Effective Mid-November 2008 Medicare will be consolidating the reports they return from the DME MAC Jurisdictions. The rejections performed and returned on the Genresponse report will be updated to handle edits currently being performed on the DME MAC Level II Report.

***The DME MAC Level II report will no longer be generated and returned to clients.

Confused by Electronic Medical Claim billing then read these articles on Billing Health Insurance medical claims

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Kansas, Nebraska and Western Missouri Medicare Updates

RelayHealth was updated with new information regarding Wisconsin Physicians Service (WPS) about processing change to the Part B processing system for Kansas Medicare, Nebraska Medicare, and Western Missouri Medicare. The WPS change will allow for consistent processing for the Jurisdiction 5 Medicare Administrative Contractor (MAC) and automate many of the current manual processes allowing for more accurate and timely payment. These new changes will benefit providers and medical offices.

The change will affect claims processed November 1, 2008 and after.

The payors affected are listed below:
CPID# Insurance Carrier Name
2463 Kansas Medicare
1451 Nebraska Medicare
4451 Western Missouri Medicare

RelayHealth has identified the following items for you to be aware of with this change:
WPS Medicare Part B will have a system dark day on October 31, 2008
No customer service activity. The Provider Call Center representatives will not have system access.

* Interactive Voice Response (IVR) access will be available for registered C-Snap users.
* RelayHealth will send claims to WPS on October 31, 2008; however, claim processing will not begin until Monday November 3, 2008.
* WPS will output reports on Tuesday November 4, 2008. RelayHealth will output reports when they are received from WPS.

Please review your reports and expect an initial delay in processing of claims.

To read more about Medicare updates including Billing Health Insurance Information check out Medicare Medical Coding and Billing Courses

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RelayHealth releasing new reports on Specific Insurance Carriers

On Wednesday November 5th 2008 RelayHealth Clearinghouse (McKesson) will be changing the electronic claims routing for the following payors:

CPID Payor Name Payor ID
1705 Advantage Health 35209
2295 Allegiance Benefit Plan Management, Inc. 81040
2227 Allied Administrators (San Francisco, CA) 94177
2230 American Bene Mgt 34187
6436 American Postal Workers 44444
8456 Arcadian Mgmt Services 77045
3781 CA Kaiser North only KS003
3472 Cedars Sinai Medical Encounter 95167
6440 Connecticare 06105
5446 Custom Bene Admin 39170
2486 Delta Health System DHS01
8451 Emerald Health 34167
2898 Health Design Plus 34158
8431 Health Plan Services 59140
3231 Medical Bene Admin 68041
2239 Mercy Care Plus 71079
1782 North American Medical Management E3510
6417 Pacific Mutual 67466
2257 QuadMed 39197
2238 Trusteed Plans Service Corporation 91078
3224 UFCW Local 400-5205 UFC97
1735 Western Growers Trust 24735
5415 Western Southern Life Group 31048
3259 Wisconsin Auto and Truck Dealers 39200

*CPID# is the 4 digit # RelayHealth uses to know which insurance carrier you are submitting your claim for
*Payor ID# is the # listed on the back of the patients insurance card. Cross reference that # to find the CPID# to submit claims through RelayHealth.

Changes that will take place for these insurance carriers is:

• Payor Agreements are not required
• Daily CLaims - Verification Statement Report will be made available
• Electronic Response Report will be made available
• RelayHealth Standardized Payor Reports will be made available

Look for these changes starting tomorrow November 5th 2008

Additional Medical Billing and Coding questions are answered here: Online Medical Coding and Billing Courses

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