1. #ZOLLSummit

2. Billing Electronic Secondary Claims Presented By: Stacey Bickford, Product Manager

3. http://www.surveymonkey.com/s/NAAC_Certs To Receive CEU Certifications

4. Billing Secondary Claims  MSP/Secondary Claims Overview  EOB Comparison  Is a separate payor/schedule necessary?  Customer and Trip Settings  Generating the electronic batch  What do I do with my rejections?  Tips to remember  Questions?

5. Electronic Secondary Payors  Medicare Secondary (MSP)  Medicaid  Major Commercial Payors (Ex: BCBS/UHC)  Clearinghouses Email Col-ProviderRelations@zoll.com for a list of ZOLL Partnered ClearinghousesCol-ProviderRelations@zoll.com

6. Why electronic secondary?  No more paper claims  No matching up EOB and claim  No need for postage  Reimbursed in 15-30 days (most payors)

7. Explanation of Benefits

8. Secondary Payor/Schedule  Separate payor not required  Separate ECM not required  Separate schedule suggested but not required  Schedule used for tracking purpose  Workflow and most billing reports can restrict by schedule

9. Workflow / Reporting

10. Opening the trip  Open trip in RescueNet Billing > Call Taking (ctrl + T)  Select trip by run number, Customer Name or SSN, then tab

11. Primary Payor Payments  Primary payments must be posted by line item  Primary payor selected on credit ( even if patient check )  Coinsurance/Deductible  REFUNDS: Must use “Refund” type credit and post as a negative amount (Coins/Deduct as negative also)

12. Add Credit

13. Primary Payment Amount  Select a “Payment Type Credit”  Select the primary payor for credit  Post the amount for that applicable charge line  Repeat for each charge line (including ancillary)

14. Edit Amounts  “Amount” reflects the payment amount for this line  “Expected” does not output electronically  Co-Insurance/Deductible for this line item  If separated on EOB, apply both in each fields

15. Line Item Posting  Don’t forget to tie the payment to a charge

16. Posting Denials  Use HIPAA Adjustment Reason Codes  RescueNet Reporting>Administration>Denial Codes  Don’t forget the $0.00 payments (by line item)!  No need to post PR1 or PR2 Ded/Coins Codes

17. Adding a Denial

18. $0.00 Credits with Denial  Must add a $0.00 credit for each line item  Apply the total charge to “Coinsurance” or “Deduct”  Denial “HIPAA Reason Code” overrides Coins/Deduct

19. DON’T FORGET!!! Importing remittances in Batch Credits/Batch Posting will do this automatically!!!

20. Batch Credits - Remittance

21. Batch Credit - Remittance

22. Batch Posting- Remittance

24. Payor Order – Modify Customer Payors must follow COB order

25. Tab 3 Settings

26. Magic COB Formula  Secondary payors perform balance checks  All line items must equal claim total  Line items must follow Magic COB Formula  Payments + Contractual Adjustments + Patient Responsibility = Gross Charge Amount

27. Magic COB Formula Payments Patient Responsibility + Contractual Adjustments Gross Charge Amount = +

28. Generating the Batch  Same ECM as Primary Medicare/Payor  Do not need to run two batches  Go to Billing>Electronic Submissions

29. Generating the Batch  Utilize restrictors if desired

30. File Submission  Transmit.dat file for the batch  File located in Central Share>BillSave>batch#.dat  Process no different than Primary Claims

31. Rejections  Review 997/999 or.rsp/277CA file  Contact payor EDI for detailed information  Obtain Loop/Segment for rejection  Contact Billing Support (800) 663-3911 opt. 3

32. Tips to Remember

33. Secondary Claims Tips Payor order in Modify Customer Primary payor on Tab 3 Old Denials for payors above Secondary Supplemental Values Line item posting (Payments) Lumping/Combining combines credits Magic COB Formula