KyHealth Choices

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KyHealth Choices

• CMS 1500 Medicare Crossover Workshop

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Agenda

• Representative List
• Reference List
• 837 Requirements
• Medicare EOB examples
• How to Code your Medicare Primary Claims
• Helpful Hints
• How to Bill Medicare Primary Claims to KyHealth
  Choices
• Evaluation

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Representative List
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Representative List
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Reference List

• Helpful Phone Numbers
• EDI Helpdesk
• 800-205-4696
• ky_edi_helpdesk_at_eds.com
• Provider Billing Inquiry800-807-1232
• ky_provider_inquiry_at_eds.com

• Web Addresses
• EDS Website
• www.kymmis.com
• KyHealthnet
• http//home.kymmis.com
• KyHealth Choices
• www.chfs.ky.gov/dms

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Billing Crossovers to KyHealth Choices

• Beginning September 29, 2008, KyHealth Choices
  will require providers to prepare their own
  Medicare/Medicaid related claims.
• If you bill these by paper, a coding sheet will
  be required with your claim form. Use black ink
  only.
• You will no longer send Medicare EOBs with your
  claims unless Medicare denied a service.
• You may bill Medicare Primary claims by
  electronic means.

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837P Claims Submission

• The 837P Companion Guide Version 3.0 will be
  available on the EDS website www.kymmis.com
• Contact your Software Vendor to check the
  capability and readiness for these changes.

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837 Requirements

• Loop 2320 AMT02 - Payor Paid amount Medicare
  paid amount
• Loop 2320 AMT02 - Payor Paid Amount Medicare
  Allowed amount
• Loop 2330B DTP01 - Date Claim Paid Medicare EOB
  date qualifier
• Loop 2330B DTP03 - DTP03 - Date Time Period
  (CCYYMMDD)
• Loop 2430 CAS01 - Claim Adjustment 'PR' Patient
  Responsibility
• Loop 2430 CAS02 - Claim Adjustment Reason Code
  '1' Deductible or '2' Co-insurance
• Loop 2430 CAS03 - Monetary Amount
• Loop 2430 CAS04 - Quantity Adjusted units
• For questions please contact EDI at 1-800-205-4696

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Medicare EOB
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Required Information

• Medicare EOB Date
• Medicare Paid Amount
• Medicare Allowed Amount
• Medicare Coinsurance Amount
• Medicare Deductible Amount

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Helpful Hints

• First arrow shows Medicare paid the allowed
  amount in full. You will not bill this line to
  Medicaid as no coinsurance or
• deductible is due.
• Second arrow shows Medicare paid zero but left
  deductible due. In the Medicare paid amount
  field, enter zero as the amount paid.

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Helpful Hints

• A submission on paper or by electronic means must
  not be sent until you are sure the Medicare
  electronic Crossover was unsuccessful or denied
  by KyHealth Choices to avoid duplicate billing.
• If Medicare denied your charges, the claim must
  still be submitted to KyHealth Choices by paper
  claim with the Medicare EOB attached.

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Medicare EOB
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Coding Sheet
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CMS 1500 KyHealthnet Header
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CMS 1500 KyHealthnet Detail
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Medicare EOB
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Coding Sheet
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Coding Sheet
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Coding Sheet
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Medicare EOB
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Coding Sheet
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