fsgl wrote on Sunday, June 22, 2014:
James,
Great to hear that Stephen has resolved the matter for you. (Presume that DN was used because that was your choice in your second post.) Always good to have the paper claim as a fallback if there’s a problem with e-claims.
Because your practice is already set up with Office Ally, no further work is required on your part for the secondary claims. Our Medicare carrier would indicate on an EOB which claims had been forwarded to the secondary. Two reasons to ignore this.
Reason 1, sometimes they do and sometimes they don’t. You end up wasting time waiting for the secondary payment; when the billing person calls the secondary for the claim status, only to learn the crossover never occurred in the first place.
Reason 2, if the percentage of governmental claims (Medicare and Medicaid) is under 50% of the total per month, there is no charge. Sending all the secondary as a matter of routine will ensure that the percentage will stay under 50%, therefore Office Ally will not bill your practice. 20 bucks is not going to send the practice to the poor house, but it’s enough to treat staff to pizza, thereby increasing good will. The worse thing that happens is that secondary carriers will say that yours is a duplicate claim after it had been forwarded by Medicare.
It’s a good idea to have staff check the “Needs secondary billing” box after they had posted the Medicare payment as suggested by CVerk. Our office uses the Batch Payment module for Medicare payments because the posting goes faster. There is no equivalent box to check in this module. It automatically sets up the claims to be submitted to the secondary in the Billing Manager.
Occasionally paid secondary claims pop up in the Billing Manager. Paid claims need to be dispatched as “Mark As Clear”. No point submitting a claim that has been paid.
The format for the electronic claim is known formally as ANSI X12 version 5010. The 837P, or document type, is the part of the file sent by physicians, which roughly corresponds to the CMS 1500. The ANSI X12 5010 837I corresponds to the UB-04, paper claim; sent by hospitals, nursing homes and home health agencies. P = professional (us); I = institutional (the other folks). 835P is the Electronic Remittance Advice, or the data file corresponding to the EOB. That’s ANSI X12 for Medicine in a nutshell. For more background information on the topic, see this webpage.