How to bill to 2 different primary insurances

tsvas wrote on Wednesday, January 11, 2012:

For Healthy Kids - we have to bill vaccine administration charges to Medicaid HMO company, and actual vaccine cost to Medicaid.  i.e. both of they are primary insurance companies.  How can we manage it?

yehster wrote on Wednesday, January 11, 2012:

How did you do this before OpenEMR?  I’m assuming you are using X12 for billing and not HCFA. Would you submit the HMO claim and the Medicaid claim to seperate clearing houses?

I don’t really have an answer, but knowing that each patient is only allowed one entry as Primary Insurance (which would be hard to change) I suspect the solution isn’t going to be simple.

tsvas wrote on Wednesday, January 11, 2012:

We started the practice with OpenEMR :slight_smile:

I heard from the provider relations department that we have to submit admin charges to HMO, and vaccine charge to Medicaid.  Not sure how we do it technically.

Any ideas please.

jenjhall wrote on Thursday, January 12, 2012:

Hi, please correct me if I am wrong since I haven’t done this specific action but I believe you would have to create a second encounter for each visit and bill that one for the separate service.  When that second service is selected to have its X12 file generated you would need to make sure that the correct insurance company is selected underneath each client’s name in the Fees>Billing screen.  This is a stopgap solution that would probably be too tedious for a long term but it doesn’t require any programming. - Jen

tsvas wrote on Thursday, January 12, 2012:

Jen, I thought of creating separate encounters.  But, the problem is - in EMR, one patient can have only one primary insurance per day.

tsvas wrote on Monday, January 16, 2012:

Any ideas/solution please.

sunsetsystems wrote on Monday, January 16, 2012:

Sounds like the need is for multiple insurance profiles per patient.  This would take some work.

Rod
www.sunsetsystems.com