1.
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Will there be any changes in the process in which you adjudicate anesthesia and pain management claims? |
MedCost is not aware of any changes nor will be making a change as related to HIPAA.
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2.
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Are the current requirements such as ASA or CPT codes, units or minutes, or using certain modifiers going to change with the new HIPAA requirements? |
No. They will not change.
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3.
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What are the required fields for anesthesia and pain management providers when filing electronically and by paper in the new X12-4010 837 format? |
This question should be directed to your software vendor for additional information. MedCost required fields are not changing.
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4.
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Will there be patient eligibility verification tools available via the Internet? |
This question is non-applicable to MedCost since we are not the insurance company and do not pay claims.
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5.
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Are EIN’s or Specialty numbers needed for referring physicians in order to pay the claim after 10/15/03? |
According to Emdeon Companion Document this is a required field for Referring Provider Identifier (this is in loop 2310A, NM 109 segment). While it is not required for repricing, we would recommend that you be prepared to include this information for continuity.
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6.
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Is a Provider Specialty, and ID Qualifier or Facility Code Qualifier needed in the location data in order to be paid? |
Yes.
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7.
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If we bill facility fees to you now, using a modifier to indicate the facility portion, how should we submit our claims after 10/15/03 in order to get paid? |
Continue to file in the same manner as pre- October 16, 2003, CPT code per detail line with applicable modifiers to define the service further.
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8.
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Does MedCost require a Trading Partner Agreement with our office? |
No. MedCost does not require a Trading Partner Agreement with your office.
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9.
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If you receive paper claims directly from providers, do you convert these to electronic claims? |
No.
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10.
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How are non-network claims handled? |
After implementation we will use the logic in X12-4010 837 to allow non-repriced claims to be transmitted in our electronic file.
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11.
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How are duplicate claims handled? |
Repriced duplicate claims received electronically are routed electronically via Emdeon to payer.
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12.
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List mandatory data elements to reprice medical/professional claims. |
See Companion Guide for the complete list.
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13.
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List mandatory data elements to reprice hospital/facility claims. |
Policy information, facility name, tax ID and billing information, billed amount, patient information including ssn, dos, diagnosis codes, procedure codes –type of bill.
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14.
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We are currently sending secondary paper claims. Will you accept them? |
We will pass coordination of benefits information in our electronic file for those payors that are accepting X12-4010 837 files through Emdeon.
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15.
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As a primary payer, will you be processing electronic COB to secondary payers? |
N/A to MedCost.
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16.
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Will you accept a secondary COB without an EOB? |
Yes.
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17.
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Who is your contact if we have electronic claims processing issues with your organization? |
Customer Service Contact Center Unit 1-800-824-7406.
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18.
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What is your process for proactively monitoring and notifying providers of claim failures? |
Rejects at a file or claim level will continue to be received from your electronic software or clearinghouse vendor. For information regarding MedCost's specific data requirements, please review our Companion Guide, available by clicking here. (Guide is Acrobat PDF Format)
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19.
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After October 16, 2003 will you continue to accept the old format (legacy claims) for claims with dates of service prior to October 16? |
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claims filed originally for after 10/16/03 would expect to be
in the X12-4010 837 format. MedCost anticipates that there will
be some flexibility in continuing to accept claims in a format
that does not specifically comply with the X12-4010 837 specifications.
Yes, as long as it passed the Level 3 Emdeon review for syntax and content.
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20.
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If you encounter any problems are you prepared to receive other formats (legacy claims)? |
The information that we have been provided by Emdeon is that they will continue to accept legacy formats and populate into an X12-4010 837 format during a transition period. They will continue to perform edits as Level 3, which we understand to consist of syntax and content edits. Our goal is to provide a level of flexibility between ourselves and Emdeon that does not adversely affect or disrupt our customers.
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21.
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Will you charge any additional fee for accepting non-EDI standard transmissions? |
No. |
Updated July 19, 2007