We would like to have the ability to attach electronic EOB's to medical insurance claims. Certain insurance carriers are not accepting paper COB claims, only electronic.
Currently we think that NEA Fast Attach only works with dental claims.
This is correct, medical insurances don't accept NEA and no longer accept paper claims. Most have their own internal way of getting info (most involve us sending a claim and then the insurance mailing us a request for xrays or notes and us mailing it back). In Minnesota, some of our carriers take AUC attachments (we put a number on the claim, then fax the supporting docs with a cover letter that has that AUC number on it, too), but that's hard to figure out where to put that number in WinOMS. Granted, I don't expect you to change the system just because MN is doing something differently.
Our biggest concern is still to see that the guidelines mentioned in this discussion incorporated. If they have been already, we have not known to test it.
Hi matt.ackerman, can you give us an update on this situation? We've spent all morning trying to get secondary payment to Medicare (with a big thanks to omsnashville and her previous experience). We have a cumbersome workaround involving waivers and paper claims, but were informed by the reps that providing this information electronically is required by Medicare and that this workaround may or may not continue to be effective since other clearinghouses have the capability of sending this information just fine. They stated that any software or clearinghouse that cannot provide this information but is billing Medicare is in violation of Medicare guidelines. We've started getting the same push-back from medical companies using the AUC form; since there's an acceptable way to submit primary payment info via the guidelines posted in the discussion Kristina links to above.
We also need to know how to do this. If Medicare requires everything electronic, CS has to be able to comply. If you have figured out how to do this, would you please share? My email is email@example.com.
Medicare payors to send attachments electronically require the same or similar method of submission. Per payer guidleines, client is to fax over the required missing info, but must also include several payor assigned #'s [ICN/ACN] in the resubmitted claim. Offices need to be able to send medical attachment requirements needed in the batch electronically. They actually fax in the attachment, but they have to add the following information to electronic claim. These settings are located now under the medical ailment section in software and were added specifically to address requirements set forth by Medicare payors to attach electronic attachments. You will need to look up the requirements online which specify the steps to follow through to ensure they are the same. I wish it were as simple as sending through NEA for dental attachments, however, NEA was previously contacted and advised us that medical attachments was not an option at the time. I may have asked before but could you please send me your account # and email address. I received your latest inquiry about the update. We can get someone to contact you from our R2 team to speak with you about the current update. Also if you want to see what enhancements and what was fixed in the current release v18.104.22.168 follow the link below: http://www.carestreamdental.com/ImagesFileShare/.sitecore.media_library.Files.Support.System_Requirements.ReleaseNotesWinOMSv92.pdf
The insufficiency of this method is that our fax reaches BCBS-TN a couple days before the e-claim itself does, because of the clearinghouse process delays. Since they don't have a claim to attach the fax to yet, it just sits in an imaging folder at BCBS; they are not automatically linked for review by BCBS unless they are received on the same day. So, even though we send with ICN/ACN on the claim (entered via Medical Ailments) and fax the appropriate info with BCBS's own cover sheet, we still have to call a few days later to say, "Hey, now that you've got both the claim and the fax, we really need you to process them together." Conversations with our BCBS provider rep haven't gone far regarding this, since they already indicated they want the information transmitted directly on the e-claim, and tell us we are in violation by not sending the info as requested.
Being able to appropriately post the primary payment so that the information transmits electronically as they have required would eliminate the need for ACN/ICN faxes altogether.
Medicare's current manual advises to send the primary payer allowables/etc on the e-claim itself in the appropriate loops, as well (just as requested by BCBS-TN in the link above). See CMS manual, Chapter 3, section 30.5:
Primary Payer Paid Amount:For line level services, physicians and other suppliers must indicate the primary payer paid amount for that service line in loop ID 2430 SVD02 of the 837. For claim level information, physicians and other suppliers must indicate the other payer paid amount for that claim in loop ID 2320 AMT02 AMT01=D of the 837.Primary Payer Allowed Amount:For line level services, physicians and other suppliers must indicate the primary payer allowed amount for that service line in the Approved Amount field, loop ID 2400 AMT02 segment with AAE as the qualifier in the 2400 AMT01 segment of the 837. For claim level information, physicians and other suppliers must indicate the primary payer allowed amount in the Allowed Amount field, Loop ID 2320 AMT02 AMT01 = B6.
Primary Payer Paid Amount:
For line level services, physicians and other suppliers must indicate the primary payer paid amount for that service line in loop ID 2430 SVD02 of the 837. For claim level information, physicians and other suppliers must indicate the other payer paid amount for that claim in loop ID 2320 AMT02 AMT01=D of the 837.
Primary Payer Allowed Amount:
For line level services, physicians and other suppliers must indicate the primary payer allowed amount for that service line in the Approved Amount field, loop ID 2400 AMT02 segment with AAE as the qualifier in the 2400 AMT01 segment of the 837. For claim level information, physicians and other suppliers must indicate the primary payer allowed amount in the Allowed Amount field, Loop ID 2320 AMT02 AMT01 = B6.
Even Medicare no longer wants the primary EOB's sent via fax... they just want the info supplied on the e-claim itself.
Despite multiple conversations on this topic over the past couple years, and even being advised that it was forwarded for development in October 2016, there has been no indication of expected resolution. Compliance with this e-claim requirement is not optional for us, and the inability to comply is costing us dozens of man-hours each month as our insurance coordinators scramble excessively to resolve the mess among all payers.
Please, please make this a priority.
I will second this yet again since we are also still having issues. Our BCBS issue reflects what omsnashville stated above. Our work-around has been to use Availity for claims where all that's required is primary payment info because it takes less work to spend an hour typing everything in there than it does to fax and call and wish and hope and pray, and it brings down at least a few of the non-compliance conversations. This does not help with the fact that we are paying CareStream to send claims and also paying our business office staff to send the claims WinOMS can't!
matt.ackerman Is there ANY update on this??
I'm asking for yet another update on this situation, as we have more MN medical payers who are not accepting MN's AUC faxes (specifically everyone's favorite BCBSMN). I see Paula's response on how to do this for Medicare, and that's essentially what the AUC is, but BCBS is no longer pulling any AUC/ICN/ACN numbers to coordinate with faxes. All primary payment info MUST come on the submitted electronic claim. We're now having to manually input everything into availity to be able to get them what they want because WinOMS won't do it.
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