Handling Medicare Advantage Claims
Point And Click License For Use Of Current Dental Terminology
End User License Agreement
THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED “I ACCEPT”, YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.
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Filing The Claim With Aarp Health Insurance Provider
To file a claim with AARP Health Insurance, youll need to call the customer care center at 1-800-444-6544. The automated response line is open 24 hours and day with express instructions on how to file a claim. If youd rather talk to a representative about the claim process, call between the hours of 7 a.m. and 11 p.m. on weekdays and 9 a.m. and 5 p.m. on Saturday. All hours are in EST and there are no representatives available on Sundays.
AARP, or the American Association of Retired Persons, is a non-profit organization that supports people age 50 and older. There are branches of the organization in all 50 states. Health coverage is provided to AARP members by Aetna Health branded to AARP.
License For Use Of Physicians’ Current Procedural Terminology Fourth Edition
You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services . You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website.
Medicare Remit Easy Print Software
Are you still using the SPR? Save time and money by taking advantage of free MREP software now available for viewing and printing the HIPAA-compliant ERA. The MREP software gives providers and suppliers the following abilities:
- Easy navigation and viewing of the ERA using your personal computer
- Print the ERA in the SPR format
- Search capability that allows providers and suppliers the ability to find claims information easily
- Print and export reports about ERAs including denied, adjusted and deductible applied claims, and
- Easy-to-use method to archive, restore and delete imported ERAs
Providers and suppliers can view and print as many or as few claims as needed. This will be especially helpful when you need to print only one claim from the remittance advice when forwarding the claim to a secondary payer. This free software can save you time resolving Medicare claim issues. Take advantage of the MREP features unavailable with the SPR.
In order to utilize the MREP software, you will need to receive a HIPAA-compliant ERA. Contact the EDI help desk or visit the website to find out more about MREP and/or for information on how to receive a HIPAA-compliant ERA. Take advantage of this new software, begin using MREP today.
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How To Bill Medicare Secondary Claims
Medicare isnt always primary. In this instance where Medicare is secondary, youll bill the primary insurance company before Medicare. Then, you can submit an Explanation of Benefits from the primary payor with the claim. The primary payer must process the claim first, and if they dont, your doctor may bill Medicare.
How Should I Ensure My Claims Are Also Filed With Medicaid
Many Medicare beneficiaries also qualify for Medicaid due to having limited incomes and resources. Medicaid pays for Medicare co-pays, deductibles and coinsurance for enrollees who see providers that accept both Medicare and Medicaid.
Show your health care provider your Medicare and Medicaid I.D. cards when you check in for your office visit. You should also show the provider your Medicaid managed care plan card .
Read more here about Medicaid benefits for Medicare enrollees.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He also has held consulting roles, including as an associate at Sachs Policy Group, where he worked with insurer, hospital and technology clients.
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Entering Payer Information Into Your Client’s Profile
Now that you’ve assessed your payers’ enrollment requirements, you can enter your client insurance information into their profiles if you haven’t already done so.
- Go to Client Profile > Edit > Billing & Insurance tab. Enter the payer either by payer ID or by typing in the keywords for the payer.
Note: You can add a payer to a test client’s profile if you want to submit an enrollment in advance.
How To File A Medicare Claim
Most of the time, you wont need to worry about filing your own Medicare claims. Since most providers accept assignment, they file the claim for you. But, knowing how to do it will come in handy in case you need to file your own claim. If you need to file a claim, its possible the provider you saw doesnt accept the assignment. Your claim goes according to Medicare reimbursement rates, even if the bill was more than Medicares amount. Claims must be sent in no later than 12 months after the service.
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Working With Your Healthcare Provider
Tip: Your MSN is not a bill. However, if it shows that you may owe money to a provider for services or supplies you received, you may get an additional bill directly from that healthcare provider.
Determining Which Payers Require Enrollment
You can quickly and easily locate the insurance payers you work with and assess whether they will require you to enroll to submit claims electronically. Payer IDs and payer names can be specific to the clearinghouse they work with. If you’re having difficulty finding a specific insurance payer, please reach out to our Insurance Team, and we’ll be able to verify the payer ID for you. You can send us the secure SimplePractice client URL with their insurance card uploaded, and we will be able to either verify the payer ID or create a case with our clearinghouse to do so. If you need help uploading the insurance card, you can review Setting up insurance billing for your clients.
Note: Payment reports, if available from a payer, will always require enrollment.
- Go to Settings > Insurance Payers.
- In the text field, begin typing your payer’s name or payer ID to locate your payer.
- Keep in mind that many insurance payers may be listed under a single payer ID, so don’t worry if there is a large grouping of names with your payer. The payer ID for almost all payers is the only significant piece of information our clearinghouse uses to ensure the claim you submit in SimplePractice is sent to the correct payer. For more information on how to file claims to Magellan, please see .
Note: The Insurance Payers list only shows the first 50 payers on the list. You’ll most likely need to use the search option to find the correct payer.
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Submitting A Claim To Medicare
Tip: If you don’t have access to the internet, call 1-800-MEDICARE and explain the situation. They will mail a paper form for you to fill out.
How To File A Medicare Claim Yourself
If you need to file your own Medicare claim, youll need to fill out a Patient Request for Medical Payment Form, the 1490S. Make sure its filed no later than 1 full calendar year after the date of service. Medicare cant pay its share if the submission doesnt happen within 12 months. You can log in to MyMedicare.gov and view your claims to ensure they are being filed in a timely fashion. If your claims arent being taken care of, contact the doctor and ask them to file the claim.
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Who Submits Medicare Claims
For the most part, your doctor will submit claims to Medicare. But, in some instances, like foreign travel or doctors that dont accept the coverage, youll file the claim. If you receive an Advance Beneficiary Notice of Noncoverage and decide to proceed, its best to request your doctor submit the claim to Medicare before billing you.
Using The Express Plus Medicare App
You can make a claim with the Express Plus Medicare mobile app on your mobile phone. Dont submit a claim if your doctor has done it for you.
To use the app, you need a myGov account linked to Medicare. If you dont have these accounts yet, youll need to set them up.
Before you start your claim, make sure you have both:
- your account and receipt
- details of the service you want to claim.
When you claim, well ask you to either give us or confirm your bank account details.
When you make a claim through the app, youll usually get your benefit within 7 days. We pay electronically into the bank account you have registered with us.
Find out how to download the Express Plus Medicare mobile app.
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Electronic Remittance Advice/electronic Funds Transfer
The ERA is available several days sooner than paper remittances, which arrive in the mail. Electronic remittances enable a provider to receive payment information on a daily basis, therefore preparing their office for a more efficient automated office management style. Providers with accounts receivable systems may have the ability to post payments electronically with ERA. Posting payments automatically can save the provider numerous hours in the office.
NGS will automatically deposit claim payment into a checking or savings account as specified by the provider through EFT. Electronically deposited funds are available in the providers account the day after Medicare transmits an EFT to the bank. This eliminates the mail time it takes to receive a paper check as well as trips to the bank. EFT conversion will bring you completely into the EDI environment.
Providers that are not taking advantage of all EDI services listed above are completing unnecessary paperwork. Providers currently using a software vendor or billing service should contact them first to make sure their system has these capabilities. Visit Start Enrollment Process to enroll for ERA online or call the EDI Help Desk for additional information.
Clearinghouse Or Billing Service
The below EDI Connection links list contact information for all vendors, clearinghouses, and billing services that have been approved with electronic claim filing for:
WPS Military and Veterans Health
Your WPS Community Manager account will allow you to verify the EDI transactions that you will submit/receive with WPS. In order for you to set up an account in WPS Community Manager, you will need to complete an initial registration process and complete the necessary request forms and business agreement.
To begin the registration process, please go to Enrollments.
- Once you have completed your initial enrollment and all required business agreements specific to your Trading Partner account, new WPS trading partners are required to submit successful test transactions in order to be approved for production. There is not a testing environment for 277, 835, or 270/271 .
- Once you have created your test file, you submit it through your Gateway Express account. Once you have submitted your test file and you are ready for WPS to review it, go to our Enrollments page to submit a request for us to read and approve your file. If the file contains errors, we will provide you with the specific errors for you to correct and resend your test file.
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