J11 Part A Medicare Secondary Payer (MSP ... - Palmetto GBA

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Submitting through PC-ACEPro32Downloaded for free from the Palmetto GBA Web site.• www.PalmettoGBA.com/J11A• Choose EDI > Software and ManualsIs a Windows-based claims processing system for electronichealth care claims submission in the HIPAA-compliantformat.MSP information entered via FISS DDE on a Medicare claimor adjustment on or after 10/05/2009 will Return to theProvider (RTP).• Press the F1 key from any claim page for an explanation of the reasoncode applied to the claim.March 201152Submitting through PC-ACEPro32March 2011When PC-ACE Pro32 is used to bill an MSPclaim, the information is entered in severaldifferent fields.• The LOB (Line of Business) field should containMCA (Medicare A) when filing the claim toMedicare as an MSP claim.• Enter the appropriate codes in the ConditionCodes, Occurrence Codes, and Value Codessections.53Sample PC ACE Pro32 PatientInfo & CodesMarch 20115418
March 2011CAS Segment – Claim LevelAdjustmentThe CAS segment is used to report prior payers claim level adjustments thatcaused the amount paid to differ from the amount originally charged. Thissegment is used if the payer in this loop has reported claim level adjustmentinformation on the primary payer’s remittance advice. This line can be repeated ifthere are multiple adjustment groups.CAS for Claim Level Adjustment Information:CAS01 = indicates Claim Adjustment Group Code CAS01 valid values:• CO = indicating Contractual Obligations• CR = indicating Corrections and Reversals• OA = indicating Other Adjustments• PI = indicating Payer Initiated Reductions• PR = indicating Patient ResponsibilityCAS02 = indicates Claim Adjustment Reason CodeCAS03 = indicates Monetary Adjustment AmountCAS04 = indicates Service Line Adjusted UnitsCAS05 = indicates Claim Adjustment Reason CodeCAS06 = indicates Monetary Adjustment AmountCAS07 = indicates Service Line Adjusted Units55Payer Paid AmountThis is required if the primary payer has adjudicated theclaim. Note: It is acceptable to show “0” (zero) as an amountpaid.AMT segment for COB Payer Paid Amount:• AMT01 = ‘C4’ indicating Prior Payment - Actual• AMT02 = Monetary Amount• AMT01 = ‘T3’ indicating Total Submitted Charges• AMT02 = Monetary Amount• DTP = indicates the Date Claim PaidThis monetary amount should match the claim total amountin the CLM 02. If you are doing claim level reporting, theTotal Primary Payer Paid amount (AMT*C4) plus theadjustment amounts in the claim CAS segments must equalthe Total Submitted Charge (AMT*T3).March 201156Sample PC ACE Pro32 COBInfo (Primary)March 20115719
Page 1: The Medicare SecondaryPayer (MSP) P
Page 5 and 6: Worker’s Compensation(WC)Medicare
Page 7 and 8: End-Stage Renal Disease(ESRD)The ES
Page 9 and 10: Special ESRD SituationsBeneficiarie
Page 11 and 12: MSP Questionnaire (MSPQ)Part I: Rel
Page 13 and 14: Top 10 Errors Found in MSPAudits6.
Page 15 and 16: Coordination of BenefitsContractor
Page 17: MSP Billing Tips andProcedures49MSP
Page 21 and 22: Submitting Claims via VendorSoftwar
Page 23 and 24: Requesting a ConditionalPayment Do
Page 25 and 26: Billing Condition Code 77Indicates
Page 27 and 28: Questions?7927

J11 Part A Medicare Secondary Payer (MSP ... - Palmetto GBA

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