The queuing for Secondary Insurance is done through Fees > Payments (or Billing > EOBS) currently with no option of adding a remittance advice code as required by Medicare. We are working on solution for this that would allow the entry of those codes and insure that they show up in the X12 file: (loop 2300 thru 2430).
Here’s the basic plan:
1) Create a list_options set for the MSP Remittance Advice Codes
2) Add a column to payment posting to allow you to select those codes at that time (new payments module only)
3) Enhance library/Claim.class.php to be able to get the codes for secondary medicare claims
4) Enhance gen_x12 to use them in the right place
5) Enhance gen_hcfa to use them if that’s possible
Currently in version 4.0 if you send a secondary claim by x12, the first CPT code usually will be correct, but subsequent CPT codes will be screwed up with stuff like a billing date in the year 1900 and no advise codes. You then usually have to fix them at the clearinghouse level to get them to go through. Luckily, most Medicare claims are billed to secondary internally by Medicare and you don’t have to mess with this.
I added a free-form text box to enter a remit code. If anyone has a free moment, please test this under some different scenarios to see if the X-12 comes out correctly, as the code is a hack. If anyone has better implementation suggestions, please suggest. In the meantime, I’ll be putting codes into a list_options list for ease of use.
Hi,
Please delay this a bit. I’d like to review it (on quick review , noted an issue in the sql inserts if list_options table ever gets modified in the future). Is this needed for 4.1?
-brady
Whatever happened with this? It is required when submitting claims to medicare via X12 to list the diagnosis codes and pointers for each procedure for a given encuonter. Has anyone had success billing directly to Medicare via a Medicare NSV? Thanks guys.