Queued for primary hcfa billing to MEDICARE


(Sherwin Gaddis) #1

9 years later.

Looking at the list above. You can see that on 05/29 secondary billing should have been done. I noticed that the tread posted in 2010 noted how the list never shows Queued for Secondary billing. It still does not.

Our dilemma is the last date on the list 06/21. We are trying to figure out what triggered this event. It should not be there. This not isolated vent either. There are a number of claims they seem to pop back up as queued when they should not be. This information is not logged as to who access the billing last or changed an entry.

This note in the forum is for anyone else out there that has noticed this. You are not alone.

(Stephen Waite) #2

hi @juggernautsei, most folks are sending medicare electronically with the 837 but you first need an EDI account, https://www.palmettogba.com/internet/elearn2.nsf/jj_edi_enroll/story_html5.html

edit: am seeing one batch.txt so looks like you are

when the remittance is electronically processed it will not queue if it was a crossover claim

(Sherwin Gaddis) #3

That is the point of this message. The user is sending electronic claims. They are not using paper claims but the system still puts these notes in the patient’s chart as though they are sending paper claims. That is the first confusing fact. Next confusing fact is that the old post that was shared, the code has not changed, it never shows the secondary billing action message. This section has been pushed along in the code base but not updated to function properly.
I do believe that the batch files are listed in the history. So, batch files would suggest electronic claims to me. I am in this section because some users are asking me to fix these things. There is a high learning curve for me to get up to speed enough to even mess with editing this code.
In a conversation with a user yesterday, he said he could not believe no one else has seen this issue. He couldn’t find any reports of the issue. I am posting the issue so that others may know.
I do hope to address this and fix the claim transaction history so that it accurately reflects what has been done.

I just want to put in here the I know you have put in a lot of work on the billing suite. I appreciate all you have done to move this section forward. It is a lot of work and sometimes very little thanks or reward for the hours spent writing code.

In reviewing the help file and knowing that the biller is new. They may be clicking the needs secondary on the manual side that is queueing the claim for billing again even though it has been paid by both primary and secondary insurance.
It would be helpful to have the history show that the claim went out to the secondary or some action was taken with the secondary insurance.

(Stephen Waite) #4

hi @juggernautsei, never seen it list batch.pdf unless generate hcfa was clicked. It has and should show the secondary billing information.

It looks like when the remit was processed it was somehow set to go back to the primary insurance instead of the secondary or the secondary insurance is the same as the primary.

(Sherwin Gaddis) #5


We think it may have been the new biller using the legacy post page to mark the encounters. We found the batch that it happened in. So, we will be watching but in the meantime. The code needs to be updated to reflect what stage of billing the encounter is in such as when it is queued for secondary billing.