Allegheny Messages

Hospice agencies reporting Non-covered days/units with Condition Code 77 due to late Notice of Election and utilizing the KX Modifier to file for an exception will see their billing claim files Returned to Provider (RTP).  Medicare is requiring the Non-covered days and total dollar amounts reported to also include the total number of non-covered units.  All covered charges will include the total number of units and dollar amounts.  These will be reported on separate lines with in the electronic ANSI 837 claim file.  However with in the ANSI 5010 Standards for 837 files, there is only one place to report total units.  The software will include the total number of Covered units in the electronic file.  Due to the ANSI 5010 Standards for 837 files, Allegheny Software is unable to make a software change to the 837 file to report the Non-covered units, nor will Medicare accept an 837 claim file modified to include these non-covered units.  Agencies will need to manually enter the Non-covered units with in the FISS System upon receipt of the Return to Provider (RTP).

Changes to the previously posted instructions are needed to correct Ohio Medicaid ANSI billing for referring and rendering physicians.  The Main office software must be updated to Version 5648 dated 1/27/15.  In the Insurance data base under the ANSI tab, Additional Items tab for the appropriate payer, there is a new section labeled 2420E Rendering Provider.  The check box for ‘Add 2420E Rendering Provider Segment must be marked.  In section labeled 2310 B, C, D, F Other Rendering Provider Information remove the check mark in ‘Add Referring Physician if Different from Rendering 1:2310F.  If the check box for ‘Add 2310 B Rendering Provider segment Loop’ was marked prior to the previous instructions, it may be left marked.  If this ckeck box was marked due to the previous instructs, please remove the check.

Available with the current software version, agencies required to include the Referring and Rendering Physician in ANSI Electronic Claims must go to the Insurance Database and select the appropriate insurance company  in the look up field.  Once the correct Insurance Company is displayed, select the ANSI tab then the Additional Items tab.  On the right side of the screen in the section labeled 2310 B, C, D, F Other Rendering Provider Information, the check boxes for ‘ADD 2310 B Referring Provider Segment Loop’ and ‘ADD 2310 F Referring Physician if different from Rendering” must be marked.

Agencies will then need to ensure in the Patient data base that each patient’s  Referring and Rendering Physician are documented.  In the Physician screen the Rendering Physician will be entered in the Primary Physician field.  The Referring Physician (if different) will be entered in the 4th Physician field.

Additional labeled instructions will be added to the Physician screen with software versions dated 1/27/15 or later.  These label changes will be in addition to the already present instructions for Hospice agencies.