cmswest wrote on Friday, August 01, 2014:
trying to setup secondary 837s to bankers as they never crossover
anyone happen to know ISA08 for them?
thanks
fsgl wrote on Saturday, August 02, 2014:
If you are asking about the Payor Id, it’s PRNT167 according to this. Often it is on the patient’s insurance card along with the contact information.
Not a big insurer because neither Office Ally, Emdeon nor Gateway have it on their lists.
Would suggest checking with clearinghouse if e-claim is possible for this insurer. A Payor ID listing does not ensure electronic claims. A clearinghouse may list a small carrier but will only submit paper claims to it.
Found something interesting on the website. See answer to question #11 about crossover claims . If supplying info for loop 2330B on the Medicare claim works, ISA08 won’t be necessary. Contact # for claims questions, 800.621.3724.
fsgl wrote on Saturday, August 02, 2014:
ISA08 is the Receiver ID. Office Ally set up the X12 Partner info for us when we enrolled with them. We do not submit to insurers directly. My mistake.
It is very unlikely that Bankers will have their own EDI to handle e-claims. If they accept claims electronically, it would be most likely through a clearinghouse and not directly. The FAQ’s made no mention of electronic claims except in question #11.
Another thought about answer #11. A subset of Medicare claims will have to be segregated with the loop 2330B information. Our Medicare carrier is NGS. In this instance, claims with crossover to Bankers can be labelled Medicare; while all others, without crossover to Bankers, can be designated as Medicare-NGS.
It should not be a problem if the insurance company data is the same provided that the title is different.
Then the question is how to have 2 837P’s. I suppose the code could be altered in such a way as to include 2330B if the claim is linked to Bankers.
cmswest wrote on Monday, August 04, 2014:
thanks for the links fsgl, i’m thinking that a payor id that starts with PRNT is getting printed out at the clearinghouse
banker’s is a pretty big secondary in my parts that seems to be set up at the patient level to not crossover
cmswest wrote on Monday, August 04, 2014:
i’ve contacted banker’s edi who will setup a sftp folder for me so i can submit directly and will hopefully get an answer to the isa08
thanks again for your help
fsgl wrote on Monday, August 04, 2014:
Your question was very compact, like a haiku. Took 2 posts, which were way off the mark, to respond to one very succinct question.
Good that Bankers accepts e-claims directly. Too bad the website does not mention electronic claims in the FAQ. Strange to have the provision, #11, but not permit patients to request crossover.
Direct submission to Bankers is less error prone than having 2 different 837P’s.
If Bankers will help with setup, sounds similar to Office Ally setup. Office Ally, via LogMeIn, filled in everything in the X12 Partner dialog. I would think Bankers will supply all the necessary information to complete X12 Partner.
Because Bankers will save money with electronic claims processing, their EDI should bend over backwards to help. But that begs the question why refuse patients’ request for claim forward, which will save them even more money. I suppose insurers, like human beings, don’t have to make sense.
cmswest wrote on Monday, August 04, 2014:
not implying that patients can’t request to have crossover setup but bankers wins by adding this red tape requiring each patient to call and request
paper claims create more scenarios for non payment thus probably justifying their current framework
fsgl wrote on Monday, August 04, 2014:
When crossovers started 6-7 years ago, every patient had to request the secondary to make the arrangement. It was awfully confusing when all this was brand new, because the primary and the secondary would argue about which carrier had this responsibility. It was only AARP who would automatically forward the claim.
Reputable insurers, like our local Blue Shield, prefer e-claims and work to get the claim paid as soon as possible (shocking thought, I know). Paper claims require opening the envelope, scanning all the stuff on the CMS 1500 & finally processing the claim. When we sent paper to Medicare with the G8427 code, their scanner would read the G as a 6 resulting in many resubmissions. Thank goodness for the 837P.
Hopefully Bankers does not have a Medigap monopoly in New England. The state legislature probably did not impose a monetary penalty for processing delays, but then insurers dislike our state for such “meddling”.
cmswest wrote on Tuesday, August 05, 2014:
got in touch with hdm corp , who handles elec file submission for bankers:
isa08 = 351980000
at some point i’ll be looking at including the bankers info in the 2330B loop in the outgoing medicare claims as your link to bankers suggests
thanks again fsgl for your help
fsgl wrote on Tuesday, August 05, 2014:
Very pleased to have been of assistance, even if it was rather roundabout.