ideaman911 wrote on Thursday, December 17, 2009:
Hi all;
We just experienced a problem which cannot be unique, but found no formal instructions to deal with it. So I will writeup a wiki and post it (as soon as my wiki login arrives) with explicit instructions how to handle the problem.
Situation: Patient provided us insurance info showing Medicare as primary and TotalCare as secondary from 1/1/2009. We learn subsequently that Medicare only became effective 9/1/2009, with TotalCare as primary until then. We had one service which we billed during the overlap, which was rejected by Medicare, and re-billing TotalCare as primary within the Billing module gets rejected because it shows TotalCare as primary and secondary on the same bill.
The correct way to deal with this is to first re-open the encounter within the Billing module by unchecking the “Unbilled Only” and refresh the list for that date, then select the encounter and select Re-Open.
Next go to the patient Demographics, select MORE, and edit the Insurance. Change the primary to TotalCare and fix the policy numbers, etc., and change the secondary to “Unassigned”. Make certain the Effective Date is the same for both, and pre-dates the encounter. Save the changes, which will now allow for billing that correctly, but not yet has the full picture for insurances.
Next open the same MORE and Insurance edit, and change the primary to Medicare, with its proper policy, etc., but the Effective Date must be 2009-09-01, and make the secondary be TotalCare with that same Effective Date of 2009-09-01. Save those changes and now when you bill for any encounter in either period, they will bill correctly.
A review of the demographics at bottom will show the each insurance with its effectivity timeline highlighted above it.
Joe Holzer Idea Man 315-622-9241 im@holzerent.com
http://www.holzerent.com