McKesson Insurance Claim Reports

Transcription

1 McKesson Insurance Claim Reports You can receive and view the following McKesson insurance claim reports in the OfficeMate Third Party Processing window: Claims Acknowledgement (CA), 2 Claims Acknowledgement (UA), 4 Exclusion Claims (UE), 5 Exclusions Claims (EC), 5 Front-End Level I, McKesson 997 (XA), 9 Front-End 277 Claim Status (XP), 10 Front-End 277 Claim Status Rejection (XJ), 11 McKesson Status of Transfer, 11 Payor (CR), 11 Recreate (FX), 12 McKesson Insurance Claim Reports 1

2 Claims Acknowledgement (CA) The Claims Acknowledgement insurance claim report is received the day after you submit the insurance claims. This report contains a list of submitted insurance claims, along with indicators to show how each claim will be distributed and if the claim failed any exclusions, which prevent it from being forwarded to the payor. The report is sorted in the order that claims were processed. The summary totals by CPID indicate if the claims for a specific CPID was sent to the Claims Control application. There is also a summary totals section by application. This report will be most useful if there are discrepancies between the number or charge amount of claims submitted from the number or charge amount of claims processed by McKesson. Once the totals are verified, the Claims Acknowledgement report becomes a historical record of claims processed. The Claims Acknowledgement report contains a list of submitted insurance claims and status/distribution indicators. Refer to the following table and report example for more detailed information on this report. Processing Date (A) Date the file was received. Claim Billing Date (B) Billing date from the input file. Customer Billing Number (C) Customer number that will be billed for charges. Billing Provider Name (D) Name registered at McKesson. Submitter Number (E) Individual submitter number. Submitter Name (F) Submitter name from the input file. D/C Column (G) Distribution Code Column. Indicates the distribution of claims. E/F Column (H) Error Flag Column. Highlights claims excluded and rejected. S/C Column (I) Supplemental Claim Column. Number of supplemental claims or additional claims created. Payor Name (J) Name of the destination payor. TSH Assigned Claim ID (K) Unique claim ID assigned by TSH. Claim ID (L) Unique claim ID assigned by customer. CPID (M) CPID of destination payor. Totals (N) Number of claims accepted and excluded. Accepted (O) Number of accepted claims forwarded to the payor. 2 McKesson Insurance Claim Reports

3 Excluded (P) Number of excluded and rejected claims. Total - Input (Q) Total number of claims received. Total - Output (R) Total number of claims forwarded and method sent. A=Electronic to Payor (S) Claims forwarded electronically to the payor. B=Carrier - Direct (T) Claims forwarded to the payor on paper. C=Patient - Direct (U) Claims forwarded to the patient on paper. E=Paper Claim - Mailbox Paper (V) F=Paper Claim - Hardcopy (W) Claim forwarded to the customer via EMF. Paper claim forwarded via mail to the customer. E=**Error** (X) Claim excluded or rejected. McKesson Insurance Claim Reports 3

4 Claims Acknowledgement (UA) The Claims Acknowledgement insurance claim report is generated by McKesson and displays insurance claim files that have been recreated due to the transmission errors between McKesson and payors. Use this report to determine which claims have been resubmitted to the payor and which claims have been excluded. 4 McKesson Insurance Claim Reports

5 Exclusion Claims (UE) The Exclusion Claims insurance claim report is generated by McKesson and displays insurance claims that have been excluded during the recreate process. These insurance claims have not been sent to the payor and must be corrected and resubmitted. Exclusions Claims (EC) The Exclusions Claims insurance claim report is received the day after you submit the insurance claims. This report is intended to be a workable report for individuals assigned to clean up submitted insurance claims so that they can be forwarded to the payor. To accommodate the efficient handling of updates, the exclusion claims listed on the report are sorted in the order of patient IDs within payor names within client form IDs (for example, the client form ID is the major sort key and the patient ID is the most minor sort key). All invalid claims for a particular payor appear together. The format of the Exclusion Claims report is modeled after the Claims Acknowledgement (UA) report so you can quickly identify information on both reports. This report contains an error/exclusion description in addition to the exclusion reason. The Exclusion Claims report also contains claim rejection information. Any insurance claims that have been excluded or rejected must be corrected and resubmitted to McKesson. Refer to the following table and report example for more detailed information on this report. McKesson Insurance Claim Reports 5

6 Processing Date (A) Date the file was received. Claim Billing Date (B) Billing date from the input file. Customer Billing Number (C) Billing Provider Name (D) Customer number that will be billed for charges. Name registered at McKesson. Submitter Number (E) Individual submitter number. Submitter Name (F) Submitter name from the input file. D/C Column (G) Distribution Code Column. Indicates the distribution of claims. E/F Column (H) Error Flag Column. Highlights claims excluded and rejected. S/C Column (I) Supplemental Claim Column. Number of supplemental claims or additional claims created. Payor Name (J) Name of the destination payor. TSH Assigned Claim ID (K) Unique claim ID assigned by TSH. Claim ID (L) Unique claim ID assigned by customer. Exclusion Code (M) Code indicating an excluded claim. Version Code (N) Version of the exclusion. Edit Level (O) Claim or detail level of edit. Error Description (P) Description of why the claim was excluded. CPID (Q) CPID of the destination payor. Totals (R) Number of claims accepted and excluded. Accepted (S) Number of accepted claims forwarded to the payor. Excluded (T) Number of excluded and rejected claims. Total - Input (U) Total number of claims received. Total - Output (V) Total number of claims forwarded and the method sent. A=Electronic to Payor (W) Claims forwarded electronically to the payor. B=Carrier - Direct (X) Claims forwarded to the payor on paper. C=Patient - Direct (Y) Claims forwarded to the patient on paper. 6 McKesson Insurance Claim Reports

7 E=Paper Claim - Mailbox Paper (Z) F=Paper Claim - Hardcopy (1) Claim forwarded to the customer via EMF. Paper claim forwarded via mail to the customer. E=**Error** (2) Claim excluded or rejected. McKesson Insurance Claim Reports 7

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9 Front-End Level I, McKesson 997 (XA) The Front-End Level I, McKesson 997 insurance claim report is received approximately two hours after you submit the insurance claims. McKesson uses the process recommended in the HIPPA documentation to perform the front-end editing on ANSI insurance claims. This process involves the use of the 997 transaction set in which syntax edits are performed and claims are rejected at the transaction set level. McKesson Insurance Claim Reports 9

10 Front-End 277 Claim Status (XP) The Front-End 277 Claim Status insurance claim report is received approximately two hours after you submit the insurance claims. This report gives detailed information on whether each insurance claim within the file has been accepted or rejected. 10 McKesson Insurance Claim Reports

11 Front-End 277 Claim Status Rejection (XJ) The Front-End 277 Claim Status Rejection insurance claim report is received approximately two hours after you submit the insurance claims. This report gives detailed information on insurance claim within the file that have been rejected. This report also displays the total number of claims that have been accepted and rejected. McKesson Status of Transfer The McKesson Status of Transfer insurance claim report is received approximately two hours after you submit the insurance claims. In the example below, P is your login number and is the month, day, and time stamp of the file transfer. Payor (CR) The Payor acknowledgement insurance claim reports vary in format. These reports are distributed by McKesson in the format in which they are received from the payors. When viewing Payor reports, scroll down completely to the bottom of the reports or print the reports because multiple payors may be included on one report. McKesson Insurance Claim Reports 11

12 Recreate (FX) The Recreate insurance claim report is generated by McKesson for insurance claims that have been recreated and resent to the payor due to payor system problems. 12 McKesson Insurance Claim Reports