Include Zero Dollar Procedures in Electronic Claim Files


Symptoms:  Procedure Codes with $0 amounts are not displaying on Medicare EOBs or the Procedures Filed column in EDI Submission Management.

Problem Description:  Medicare requires $0 procedure codes be transmitted electronically to the Medicare Claims Warehouse to meet requirements for incentive plans such as e-prescribing and ASC Quality Reporting Program.

If you use RelayHealth (formerly McKesson), CentricityEDI or Availity (using GE written plug-ins) as your clearinghouse for claims submission, you will need to ensure your system is setup to send charges with $0 fees otherwise the codes will not transmit to the carrier and you will not get credit for submitting them.  

If you utilize a HealthCo (HIS) plug-in to send claims to Availity, HCR Net, or Health-e-Web the $0 procedures are included by default.  No additional setup is required.


Resolution:  For GE Plug-ins Centricity EDI, Availity, or the McKesson (Relay Health) Clearinghouse to send electronic claims a setting is required on the Insurance Carrier (your Medicare carrier), which sets the electronic claim creator plug-in to include codes with a zero dollar fee.  

Please note: you must have the claims plug-in installed and have security access to modify Insurance Carriers in Centricity to check or make the necessary changes.

Insurance Carrier Settings
 
1) From Administration Edit Insurance Carriers, find and select your Medicare carrier (or the carrier that requires the zero dollar procedures) and click Edit (or just double-click the insurance carrier).

2) Click the EDI tab.

3) In the File Creators section, select the line for your electronic claims.
Please note: if you use electronic eligibility or have more than one Company, you may have multiple lines in this section.  It is only necessary to modify the lines related to your Claims Clearinghouse.

4) Click Edit.



Insurance Carrier EDI

CPS 10 Settings:
In the Insurance Carrier EDI window under Claims section, click the Settings button to the right of the Creator Plug-in field.



Prior to CPS 10 Versions Settings:
In the Insurance Carrier EDI window under Claims section select the Settings button to the right of the Creator Plug-in field.



Professional Claims Ins Carrier Settings

CPS10 Settings:
1) Under Other Settings check the box to Include Procedure(s) with Zero Dollar Fee.
2) Select OK and OK two more times to save the changes to the Insurance carrier.
3) Close the Insurance Carrier search window.




Prior to CPS 10 Version Settings:
1) Click the 2420A/Other tab.
2) Under Other Settings check the box to Include Procedure(s) with Zero Dollar Fee.
2) Select OK and OK two more times to save the changes to the Insurance carrier.
3) Close the Insurance Carrier search window.




EDI Submission Management

To verify the $0 dollar procedure codes are passing in claim file go to EDI Submission Management and highlight claim batch.  At bottom portion of the page look at Procedures Filed and if the claim has $0 dollar amount procedure codes they will display.  Also the Medicare EOB will show the $0 dollar amount procedure codes.




Posted Tuesday, September 18, 2012 by Jaime Hinkle
https://hiskb.healthcois.com/KnowledgebaseArticle10376.aspx