February 1, 2010, Home Health & Hospice Medicare A ... - CGS

Submit MSP Claims/Adjustments via:When:FISS DDE • Services are unrelated to an open MSP record (liability,workers’ comp, no-fault, etc.)• The primary insurance denied payment.Electronically (i.e., a billing software inthe American National Standard Institute(ANSI) ASC X12N 837 4010-A1 format(e.g., PC-Ace Pro32 v. 2.14))PaperNote: If your facility does not have awaiver due to meeting the small providerexception, (CMS Pub. 100-04, Ch. 24,§90), see the instructions below underthe “Unable to Submit ClaimsElectronically” header.• Claim is for services where another insurer has made apayment.• Claims where another insurer is primary, and there is apossibility/expectation that the primary insurer willmake a payment in the future. Example, services arerelated to a liability record; however, there was no promptresponse/payment (within 120 days) from the primaryinsurer after submitting your claim to them.• Claims where the primary insurer applied the chargesto the deductible.• Claims where the beneficiary has coverage throughBlack Lung. Refer to Cahaba’s Federal Black Lung (BL)Program Web page for additional information.Important Reminders• Correcting MSP Claims and AdjustmentsIf an MSP claim/adjustment was submitted electronically, and is returned to provider (RTP) (status/locationT B9997) for correction, you must resubmit the claim electronically. If you correct the claim via FISSDDE, the claim/adjustment will receive reason code 31265 and will remain in the RTP file.• Verify Required Data Entered Based on Claim’s Type of Bill (TOB)To avoid needlessly resubmitting an MSP claim numerous times, it is important that providers verify that allrequired claim data is present for the type of bill they are submitting (example, home health final claim orhospice claim), and that the information (including the required MSP claim data) is complete and correct.• Unable To Submit Claims ElectronicallyIf you are unable to submit claims electronically using the 837 format:Step 1: Submit a claim via FISS DDE showing Medicare as the primary payer. This will result in theclaim being rejected.Please be aware that claims may reject to FISS status/location (S/LOC) R B75XX or R B9997.If your claim rejects to an R B75XX S/LOC, it will remain there for at least 75 days. Providerswill be unable to submit an adjustment to a rejected claim until it moves to a finalized R B9997S/LOC.Home Health & Hospice February 1, 2010 42Medicare A Newsline Vol. 17, No. 5