We’ve been working with Payerpath, IN Medicare and IN Medicaid EDI departments over the past couple of months to resolve a Medicare cross over claim issue that may be affecting other Indiana PM users. The problem was that Medicare’s cross over claims weren’t including the provider taxonomy codes – that are required by IN Medicaid. As we worked through each step of the claims process, we verified that Payerpath was stripping the Taxonomy code from our claims as IN Medicare didn’t require them. So, all our secondary claims that were crossed over from Medicare to IN Medicaid, were missing this required data element – leading to 100% claim rejections. We were able to get Payerpath to remove their edit – verified the claims got to Medicare w/ the taxonomy codes – and, didn’t fail. Then, worked with Medicare to ensure the cross over claims included the taxonomy as they were forwarded to Medicaid. Once we were able to get all EDI departments to confirm the claims included the necessary data to get the IN Medicare/Medicaid cross over working – the final test was to see how they processed via our standard daily submission. As of last week, we’ve confirmed the claims are crossing over w/ the taxonomy – being processed and paid by IN Medicaid.
Prior to this breakthrough, the billing staff was absolutely buried in the manual handling of these IN Medicaid secondary claims – paper claim submissions / manual entering of charges and Medicare EOB data onto Medicaid site – crushing inefficiency. If Allscripts’ other Indiana users are having the same issues, this could really be a big help to them. Let me know if we can provide more details on this resolution.
