How to submit Medicaid/Medicare secondary claims electronically using eClinicalWorks!
March 15th, 2016 - Victoria
It has never been a cakewalk working with an EHR. You know how tough it can be, if you don’t have an eClinicalWorks expert to help you with billing needs. What do you do when you are not aware of a certain feature or a procedure?
We reached out to some organizations to know how what they did to find a solution to their problem.
Here are the top answers we would like to list down:
- Raised the ticket with eClinicalWorks EHR but yet to receive a response
- Called the eClinicalWorks EHR support and was put on hold for thirty minutes.
- Thought of navigating to the eClinicalWorks EMR’s guide but either didn’t have time OR didn’t know the correct path.
- Tried to use search engines but couldn’t find the correct link.
- Called the local eClinicalWorks experts but asked to pay to get a solution.
We have received inquiries on how to bill medicaid/medicare secondary claims using eClinicalworks EHR?
There have been many cases where organizations have reported that they suffer clearing house rejections due to secondary claims.
- What do you need to know on submitting secondary claims?
- Do you change your clearing house if you face multiple rejections?
- What if, you want to know a list of services provided that have a payer as secondary?
- How do you find it without using a reporting tool?
Related: 6 Simple steps to create secondary claims using eClinicalWorks!
You got frustrated with your clearing house and decided to send the paper claims and your secondary claim was denied. There could be other reasons for claim denials from the payer but, you might have missed to send a COB (Co-ordination of benefits) OR for the other reasons.
Your secondary claims were rejected and a kind of an error message from the clearing house which states the secondary identifier qualifier must be a valid one. You called your clearing house, EMR and payer but didn’t get to hear anything.
Suppose Medicare/Medicaid is a secondary insurance and you used a wrong code. Clearing house denies your claim. It is certainly a 5010 issue. But insurance eligibility verification is equally important.
When do you know Medicare is secondary?
These Type codes will help you know if your patient has a Medicare Secondary:
Type 12: An aged employee or spouse who’s employer has a group health plan of greater than twenty employees.
Type 13: A patient has coverage under an End State Renal Disease coordination period for the first thirty months.
Type 14 or 47: Patient has a no fault plan, includes liability or auto claims
Type 15: Patient has a worker’s compensation claim
Type 42: One who is under a VA (veteran administration) plan but has been seen in VA facility or a VA doctor
Type 43: Patient is disabled and the employer group plan has more than 100 employees
Before you proceed with billing secondary claims,
- Make sure have the ANSI code for each patient( Twelve codes to choose from and don’t expect the patients to know that)
- Don’t forget to check if the CAS adjustment code loaded into each claim line and each of the claim line is completely posted.
If you wish to differentiate between the primary and secondary claims, you can sign up with an MSP account
And most important information which is usually missed out:
- Check the EOB date and the check date in tab where you need to feed the check amount.
- Don’t miss to check if the Group number is loaded in the primary payer.
What if I have an eCW expert to walk you through six simple steps to submit secondary claims using eClinicalWorks EHR?
Let’s learn the step by step procedure for billing secondary claims through eClinicalWorks in our next article.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)Reporting Drug Wastage with Modifier JW and NEW Modifier JZAugust 15th, 2023 - Aimee Wilcox
Modifier JW has been around since 2003 with changes in Medicare policies to ensure standard utilization in 2017; however, because of a continued lack of reporting consistency, Medicare has created and implemented policy related to reporting a new modifier, JZ. How does this impact Medicare reimbursement and why is this modifier so important?Finding Patterns of Complexity in the Medical Decision Making (MDM) Table August 8th, 2023 - Aimee Wilcox
Changes to the Medical Decision Making (MDM) Table in 2023 reflect the work performed in the facility setting in addition to the work involved in Evaluation and Management (E/M) scoring in other places of service. Taking the time to really look closely at the MDM Table and identify patterns in wording and scoring helps coders to understand scoring in an easier way.Seven Reasons to Standardize Medical RecordsJuly 18th, 2023 - Aimee Wilcox
The standardization of medical records offers numerous benefits for healthcare systems, providers, and patients. By ensuring interoperability, improved workflows, better patient safety, supporting research endeavors, and optimizing resource allocation, standardized records contribute to improved efficiency, quality of care and especially patient outcomes. Here are seven reasons to standardize medical records.Advancements in Coding Hospital Observation Care Services in 2023July 4th, 2023 - Aimee Wilcox
Hospitals are increasingly adopting innovative solutions to improve patient care and optimize processes and many of these solutions follow immediately the recent CPT and Medicare coding changes. In 2023 coding of hospital observation care services underwent significant changes enabling healthcare providers to accurately document and bill for the sick or injured patient that requires a higher level of medical services between the emergency room care and hospital admission. This article explores the key changes in coding hospital observation care services and their impact on healthcare delivery.Be Aware — Emergency Department Visits Under OIG ScrutinyJune 20th, 2023 - Wyn Staheli
Every year the Department of Health & Human Services Office of Inspector General (OIG) creates an official work plan giving everyone a heads up as to what they are going to be reviewing. The 2022 Work Plan stated that they would be reviewing claims for Evaluation & Management services provided in an emergency department (ED) setting.OIG Audit Reveals Diagnosis Reporting Problems Affecting Risk Adjustment ScoringJune 15th, 2023 - Wyn Staheli
The Office of the Inspector General (OIG) recently published their Spring 2023 Semiannual Report to Congress. This report contained some diagnoses reporting issues that all providers need to be aware of. They focused on several groups of diagnoses that they considered “High-Risk” for being miscoded. Several states were included in the report and the types of errors for all can be generally grouped into several categories.Documenting for Suture and Staple Removal E/M Add-On CodesMay 30th, 2023 - Aimee Wilcox
Historically, the 10-day and 90-day global periods would include the patient's follow-up Evaluation and Management (E/M) services and any dressing changes or staple/suture removal related to the surgery; however, following a closer analysis of these and other surgery codes, the decision was made to make significant revisions to these codes to ensure proper reporting.