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Claim Rejected Claim Filing Indicator

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pecbilling:
I have tried sending a patient's claim electronically and it keeps getting rejected for entity's claim filing indicator, after some searching online I figured out what the claim filing indicator should be but where/how do I change the claim filing indicator? I have even tried sending this patient's claim paper also thinking that might work but Medicare keeps sending it back to me. Any help would be really appreciated!! :)

RichardP:
You seem to be asking the folks here to tell you how your software works.  That is what you would use to change the Claim Filing Indicator, regardless of whether you are filing electronically or paper.

You need to find out from your software vendor how to do what you are trying to do.

Our software checks the "Medicare" box in Box 1 of the CMS 1500 Form automatically - based on the fact that we have selected Medicare as the insurance for that patient.  If we select any other regular insurance (Blue Cross; HealthNet; Cigna; Aetna, etc.), the "Other" box is checked in Box 1.  But I have no clue how to make that happen.  The software does it, based on the insurance choice we make.  However, if we filled out the CMS 1500 Form by hand, we would check off whichever box is relevant in Box 1 at the top of the CMS 1500 Form.

Here are some instructions for:

Kareo
http://www.kareo.com/help/knowledge-base/50180000000UZZvAAO/claim-rejection-other-payer-claim-filing-indi

Medicare: pg. 10 of document (bottom of page), or; pg 13 of 65 pdf calculation
http://www.rmcok.com/help/medicare/CMSClaimForm.pdf

shanbull:
What software are you using?

Definition of claim filing indicator from eClinicalWorks: A code used to indicate whether the information in this payer record should be fully validated and the claim forwarded to the indicated payer OR whether the information in this payer record is for informational purposes only.

We have only 3 options to choose from: P = payment is being requested of this payer only (we almost always use this); M = payment is being requested of more than one payer at the same time (have never used this, do not use it even if there are multiple insurance policies or you will confuse the insurers); I = payment is not being requested of this payer. The claim is being submitted for informational purposes only (very rarely used).

As for where to enter the info, that depends on what your software is. Usually it's somewhere on the insurance section of the claim.

pecbilling:
When I first posted this, I didn't realize the claim filing indicator would be through the software program, sorry about that. We use Emdeon to transmit our electronic claims and they accept the patient's claim but Medicare rejects it when they get it, which makes me think it's something with Medicare and not our system. I have looked at this patient's account with a fine tooth comb and I see nothing different about this patient's Medicare input and every other Medicare patient we have input in our system. That's why this is so mind boggling. I called Medicare yesterday and explained everything that was going on and the woman I spoke to said she's never heard of that rejection code, she told me to send the claim electronically with STAND ALONE on it.  I tried that yesterday so I guess I will find out soon enough if Medicare accepts it. I think the big problem that might be holding all this up is the patient has Workers Comp insurance for anything related to his back (our claims are not) but that is what Medicare has as the patient's primary insurance, I had the patient call Medicare about this and they told him his workers comp would not cause any problems with us filing his claim. At first the woman at Medicare was telling me to submit the claim to the patient's workers comp plan get the denial then send it to Medicare but she backtracked on that, don't feel real positive that she knew exactly what she was talking about! I also called over to the surgery center where the patient had surgery and they had no problems getting their claims to go. Hopefully what I tried yesterday will work but I'm not feeling very positive about it.

shanbull:
Not sure what jurisdiction you're in, but our new Medicare administration company has a terrible call center, with people who have no idea what Medicare's policies are. Very seldom do I find it worth calling, and most of the time I find the answer I need on Google while I'm still on hold anyway. They actually do more harm than good a lot of the time. If you do call, make sure you insist on talking to the next tier level or the person's supervisor if what they're saying sounds like nonsense (because it probably is nonsense - seriously, the fact that the call center person has never heard of a claim filing indicator rejection says a lot, clearly she has not been on the job very long).

We did recently have a claim with a similar issue, it kept getting rejected for the claim filing indicator even though it was set up correctly. I ended up having to delete the patient's insurance out of the claim completely and re-added it. That did work. Another option is to delete the claim (only do this if your software will manually re-spawn the claim). Sometimes for whatever reason the claim's file is corrupt and Medicare cannot interpret it correctly. If you can't do this, call Emdeon and ask them to advise. Their tech support team actually has their stuff together, and they follow up until the problem is solved. It's always worth checking with the intermediary anyway to make sure there isn't a bug.

I also do have a lot of experience with worker's comp and auto insurance confusing things. But I'm suspicious about this being the reason, because I've never heard of Medicare refusing to accept a claim for processing because of COB issues with the claim filing indicator as the denial reason. Usually they will process it and reject for "liability of no-fault carrier," and then you appeal with evidence to the contrary, and Medicare pays. If this claim has nothing to do with the worker's comp case, the woman at Medicare is absolutely wrong in saying that you should submit the claim to the worker's comp insurance. If anything this will just mess things up even more and flag all your future claims as being related to the worker's comp case so that you have to appeal every single claim (I've been through this, it is best avoided). Also I've never heard of writing "STAND ALONE" on a claim. Electronic claims aren't even read by humans during the first pass at Medicare, so writing notes on them is generally pointless. This is definitely sounding less and less like a coding error to me, and more like an issue of the data being scrambled either between you and Emdeon, or between Emdeon and Medicare. In any case, Emdeon is the common denominator here, and they can look at the raw coding for you and tell you if they're seeing anything weird happening with the claim data, or if something with their system is causing the issue. And you can even ask them to talk to Medicare for you so you don't have to go through the frustration.

If you are able to get the correct rejection from Medicare ("liability of the no-fault/worker's compensation carrier") and would like assistance with appealing, feel free to post again and I'll give you some tips on that.

And as a general rule to keep your sanity intact, do everything you possibly can to avoid ever speaking with people at the Medicare call center  ;)

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