Relay Health Medicare Secondary

[PPS3510]

I need HELP!!! I have a continuous problem with filing Medicare as a secondary (Aetna-primary; Medicare-secondary). I can file it and send it but Medicare claims they NEVER receive the claim and/or never get the primary insurance processing information. I have contacted Sunrize (who we use for MediSoft support) and feel like I'm getting no where. I know I can not submit paper claims to Medicare with the primary EOB...so does anyone have any guidance on this topic?

TIA

[Gavin Walker]

Are you using Revenue Management to submit you claims in ANSI 5010 format?

[PPS3510]

yes we are

[Gavin Walker]

On the Process Claims window in Revenue Management go to Select -> Pri. & Sec. -> Ready to Send to select both primary and secondary claims to submit on your next batch.

[PPS3510]

I am having the same issue. Medicare continues to not get the information for processing from primary EOB. Is there a place I need to add a claim number or something? We cant issue a paper claim w/primary EOB and unable to attach eobs via RM.

[Gavin Walker]

On the Case -> Medicaid and Tricare tab there is an Original Reference field. Enter the clam number there. In some cases they also need a Re submission Number. Enter that in the field just below.

[mbpros]

First, are you posting your primary claim payments via ERAs? If not, you must (if the payer offers it). If you post ERAs from the primary payer and then send to the secondary, 99.5% of the time the claims will process correctly by Medicare. Secondly, make sure on the Policy 2 tab under Medicare Secondary Reason code you have the correct Medicare reason selected for the patient. If you have the incorrect reason selected, Medicare will deny the claims even if all of the EOB info is accurate. If you are unsure about the Secondary Reason code for a patient, you can call Medicare.