Online Claims Entry Adjustment, Void and Re-bill. Presented by: Xerox State Healthcare, LLC Provider Relations

Transcription

1 Online Claims Entry Adjustment, Void and Re-bill Presented by: Xerox State Healthcare, LLC Provider Relations

2 Resources When online use: Ask Service Representative Call Center or New Mexico Web Portal Provider Information section Links and FAQ section Provider Login section

3 Important State Websites STATE WEBSITE: PROGRAM POLICY MANUAL BILLING INSTRUCTIONS REGISTERS AND SUPPLEMENTS:

4 Adjustments A paid claim can be adjusted. Providers CAN NOT adjust a denied claim. ONLY Claims that have been processed through Online Claims Entry can be adjusted online. Claims processed through EDI or on paper CAN NOT be adjusted on the web portal. Attach any new attachments pertinent to the adjustment. 4 September 2009

5 Adjustments Filing Limit Adjustments must be submitted within 90 days from the date on the RA, for the paid claim. 5 September 2009

6 Submitting an Adjustment

7 Adjustments Enter the Recipient ID, TCN, Action & Adjustment Reason Once this information is submitted, all data associated with the previously submitted TCN will appear. 7

8 Adjustments 8

9 CMS-1500 Adjustment Form Make any changes to the existing information provided All data associated with the previously submitted TCN will auto-populate. 9 5/11/13 5/11/13

10 CMS-1500 Adjustment Form Make any changes to the existing information provided All data associated with the previously submitted TCN will populate. 10

11 CMS-1500 Adjustment Make any changes to the existing information provided All data associated with the previously submitted TCN will populate. 11

12 CMS-1500 Adjustment Add or Change any applicable Line Item Informati 12 All data associated with the previously submitted TCN will populate.

13 CMS-1500 Adjustment Make any changes to the existing information provided Change Total Charge if line items have changed Change Prior Payment if information has changed Indicate Amount Due, if necessary X Once you submit Adjusted claim, you will received a new TCN # 13

14 UB-04 Adjustments

15 UB-04 Adjustment Make any changes to the existing information provided 15 All data associated with the previously submitted TCN will populate.

16 UB-04 Adjustment Make any changes to the existing information provided 16

17 UB-04 Adjustment Make any changes to the existing information provided All data associated with the previously submitted TCN will populate. 17

18 UB-04 Adjustment Make any changes to the existing information provided All data associated with the previously submitted TCN will populate. 18

19 UB-04 Adjustment Make any changes to the existing information provided All data associated with the previously submitted TCN will populate. 19

20 UB-04 Adjustment Make any changes to the existing information provided 20 All data associated with the previously submitted TCN will populate.

21 UB-04 Adjustment To add additional line items select Add Service Line Items Or select Edit to make changes. All data associated with the previously submitted TCN will populate. 21

22 UB-04 Adjustment Make any changes to the existing information provided Select attachment type, and attach new attachments, if applicable 22

23 UB-04 Adjustment Add or Change any applicable Line Item Informati All data associated with the previously submitted TCN will populate. 23

24 UB-04 Adjustment Make any changes to the existing information provided X Once you submit Adjusted claim, you will received a new TCN # 24

25 Adjustments Filing Guidelines Recap Make any changes to the existing information provided on the previously submitted TCN. Only make changes to data that will impact the adjustment. Indicate Timely Filing Justification TCN number provided in the claim information section. 25 September 2009

26 Submitting a Void

27 Void Request Enter the Recipient ID, TCN, Action & Void Reason 27

28 Void Request Select Void Reason from Drop Down 28

29 Void Request X By selecting Submit the claim will be voided, a new TCN will be generated. 29

30 Claims-Rebill

31 Claims - Rebill Providers can make changes to existing claims that have denied, and rebill the claim. If used on a previously paid TCN, the claim will deny for duplicate. Enter the Recipient ID and TCN of the claim you would like to rebill. Once this information is submitted, all data associated with the previously submitted TCN will appear. All claims submitted with the re-bill function will receive a new TCN. 31

32 What Questions do you have?

33 What take away message to you have to share with us?

34 Resources for you When online use: Ask Service Representative Call Center or Provider Field Representatives ext ext

35