Kentucky-State Dependent Parameters

• Invoice Screen Special Medicare Secondary Modifiers

• Medicare Primary Payer

• Medicare Secondary Payer

• Medicaid Primary Payer

• Medicaid Secondary Payer
  

SPECIAL STATE-DEPENDENT  FIELDS IN THE INVOICE DATA ENTRY SCREEN

Screen 1--Kentucky Invoice Screen

ENTERING THE PRIMARY AND SECONDARY PAYERS IN THE INVOICE DATA ENTRY SCREEN

The system uses numbers 1-9 to designate the different type payers, these numbers we call paycodes.  With time, knowing these paycodes will become second nature.  However, at first, you may either need to write these down for reference, or use the help screen.  When your cursor is at one of these paycode fields, pressing function key F1 will display the following:

Screen 3--Paycode Choices

 

Medicare is the Primary Payer--Window in Invoice Screen--see screen 1 above

Reason for Transport -- Either enter none, 1, 2 characters per the prompt line at the bottom of the screen, or press function key F1 for the help screen

Reason For Transport Help Screen
The following are listed in the order of importance/severity: U, H, E, P/B, S, N.   Note that B is more important than S.  always use B when possible, but be prepared to specifically say why in the secondary diagnosis narrative. Leaving both characters blank is acceptable, but not advisable.

Accept Assignment -- Participating Providers Must Accept Assignment. This means at least two things: (1) You must accept the Medicare Allowed Amount on the EOB as the total amount you can collect when there is a non-zero allowed amount.  Medicare will pay 80% (if there is no deductible), and you are required to attempt to collect 20% from either secondary coverage (coinsurance) or from the patient (copay).  (2) Payment comes directly to the ambulance company rather than to the patient.

Filed -- There are two dates, the first is for the first filing, and the second is the refile date.

Paid/Rej(ected) -- Automatically set when posting payments, but can be manually changed here.

Medicare No -- HIC number copied from the patient screen.

Transported To/For--The prompt line at the bottom of the page will display your (single letter) choices.   Pressing the function key F1 will display the help screen below.

Transported To/For Help Screen

File By Modem - defaulted per the flag in the company screen parameter flags.  If Y is in this default, then this will be defaulted here.  However, there may be certain claims that need to be filed paper, even though electronic claims being used.  If  N appears here, this claim will not be extracted for electronic transmission.

Medicare is the Secondary Payer--Window in Invoice Screen--about the same as Medicare primary shown in screen 1 above.

Medicaid is the Primary Payer
Window in Invoice Screen

In the primary paycode window, when 2 is entered in the Pri Pay Code field, the top half of this window is displayed.

AppNo--Approval Number for Non-Emergency transports

Medicaid--Medicaid number extracted from the patient file

Filed--two date fields, the first is first filing date, second field is the refile date

Paid/Rej--Automatically set to either P or R from posting payments, but can be overwritten here

Date Verified -- for your won usage--the date you verified eligibility--most often not used

Start Time--Hours and minutes in military time.

Medicaid is the Secondary Payer
When Medicaid is the secondary payer, generally they will do what ever the primary does, using the same charges, HCPCS codes, diagnoses, etc.  The invoice window for Medicaid secondary is shown above in screen 1, and the field descriptions are the same as Medicaid Primary as described immediately above.