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Not sure what to do... Please help

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AllAboutU:
I have a Medicare Provider here in TX that has roughly $3k outstanding since the end of March, with no Medicare check since 5/2/14. I came on board on 4/11/14. When I started the biller previous to me was still paper billing on the CMS 1500 version 8/05. I rebilled his claims from the end of March that rejected for claim form and the new billing from April on paper using the CMS 1500 version 02/12. The claims came back rejected again for missing the back page. I have a program that is form fillable to the red HCFA form, I bill Medicaid without the back form and sent the claims to Medicare without the back page of the CMS in error. Once I received the rejection I re-mailed the claims ((this time with the back)). The re-mail was done on 6-11-14 and as of this past Friday the claims are still not on file. I have the DR I am billing for in box 17, a DN Qualifier in 17a and the doctors NPI in 17b. In box 21 I also have the ICD indicator marked. Also, the NPI is populated appropriately in 24J, 33A and 32A. What could be causing the rejections for the paper claims :-[?

He and I agreed to send the paper claims while I set him up electronically, well that's another problem. I set him up with Novitas Texas as an added user under my submitter ID. I get the approval that he is added on 6/21/14, submit the 25 "test" claims in order to go into live production. I call on this past Friday and I'm notified that the physician cant be set up under my submitter ID because I am not billing "live". Per the Novitas rep since I am using a software that uses Office Ally as their clearinghouse, I should have added the provider to the clearinghouse submitter ID. My software vendor emailed me today stating ALL the claims I have submitted electronically for Medicare came back rejected due to NPI/Tax ID mismatch to the EDI clearinghouse/submitter ID.

I am refaxing the paperwork tomorrow morning first thing linking the provider to the Office Ally clearinghouse submitter ID. But the doctor is pissed to say the least. His commercial claims are going over fine, but he wants the Medicare check like last month. He stated he can't have it held up any longer. I am thinking of emailing him and waiving his July payment. But I feel like there's nothing but excuses on my part. I truly didn't know he had to be on the clearinghouses submitter, and for the life of me I cant figure out what to do about the paper claims.

So ready to quit :-( I feel so down about this

Does any possibly know what could be wrong with the paper claims?  Is waiving the pay a good idea since he hasn't received Medicare payment in the 3 months I've been on board?

Christy:
ugh! Hate medicare!!!!

hang in there....The Office Ally paperwork for Medicare usually goes through in a few days and you should then be able to submit the claims....

Perhaps you could reduce your fee a little (not sure if it's flat or per claim, etc.) just to the amount of the time it took you to resubmit the claims.

I have had these snafus (always with Medicare) and in the end, it's always a learning experience.

good luck!

PMRNC:

--- Quote ---I set him up with Novitas Texas as an added user under my submitter ID. I get the approval that he is added on 6/21/14, submit the 25 "test" claims in order to go into live production. I call on this past Friday and I'm notified that the physician cant be set up under my submitter ID because I am not billing "live". Per the Novitas rep since I am using a software that uses Office Ally as their clearinghouse, I should have added the provider to the clearinghouse submitter ID.
--- End quote ---

Tough call because it was an error on your part. You don't setup new clients under your submitter ID.

RichardP:

--- Quote from: PMRNC on July 08, 2014, 02:05:12 PM ---You don't setup new clients under your submitter ID.
--- End quote ---

Linda, can you make sure I'm understanding this correctly please?

1.  I'm thinking the only reason a biller would have a Submitter ID is because that biller is submitting directly to Medicare, electronically??

2.  Any biller who submits directly to Medicare can submit claims for new clients under their Submitter ID, provided they do what Medicare requires for billers who are submitting directly??

3.  In this situation, the problem is caused because biller is not submitting directly to Medicare.  In fact, it is Office Ally that is submitting to Medicare.  So, yes, the MAC needs to have the providers numbers and Office Ally's numbers linked properly in their system.

I recently went through this for two clients who had been let go by their biller - a biller who was submitting multiple clients to Medicare directly, except for the two who were handed off to us.  Those two were being billed through Office Ally.  I was informed by Office Ally of the hoops we had to jump through to have us rather than the original biller bill these two providers through Office Ally.

We acquired these two clients at exactly the same time we had to switch from Palmetto to Noridian.  Clients were registered with Palmetto, through Office Ally.  That info did not get passed to Noridian (or was passed but ignored).  Noridian required doctors to go on-line to establish accounts for both, and then connect them to Office Ally.  Noridian would not allow us to do it for the doctors, they had to do it themselves.  They couldn't/wouldn't - so no Medicare payments for about three months while we obtained permission from Medicare to submit paper claims for the two.  We got requested permission and are currently billing with paper claims on the new form.  These two are difficult/problematic clients.  We took them on only as a favor to a client we already have.

PMRNC:

--- Quote ---1.  I'm thinking the only reason a biller would have a Submitter ID is because that biller is submitting directly to Medicare, electronically??
--- End quote ---

I have no idea.. I have not done that in years..I don't have a submitter ID. I use the practices existing setup or I set them up with their own.


--- Quote ---Any biller who submits directly to Medicare can submit claims for new clients under their Submitter ID, provided they do what Medicare requires for billers who are submitting directly??
--- End quote ---

I think that's true.. but again.. that's something I've not done.. old scenario.

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