Wiki Filing Medicare Tertiary Claims (Novitas)

[nbohm]

Does anyone know the secret to getting tertiary claims submitted to Medicare (especially Novitas) successfully? We cannot file them electronically through our clearinghouse. Novitas first told us they would only accept if we did send by paper but put "tertiary claim" in box 19. That worked for a few and now they say they won't accept that but only will electronically. They cannot give us specific direction on where to find the requirements for that to be successful. We don't have access to the Novisphere that they have now so not sure if we can do so through this software or not. We pretty much have this problem across the board but just looking for if anyone has success or tips on what is working to get these claims processed.

 

[hopepg]

I agree, hard to find exact answers.

One option is when you get a denial because you submitted the claim on paper is to fax a reconsideration request to Medicare. Explain that an attempt to file electronic was made but unsuccessful. Request that they consider processing the charges & include the primary & secondary EOBs. It'll take the usual 60 days for processing but might be worth it..

I did locate this document that gives instructions on electronic billing for a secondary or tertiary claim. I don't know if this will help:
http://www.novitas-solutions.com/we...state=tziq1b4g2_42&_afrLoop=1259146034620000#!

Another possibility is if you can get the tertiary claim to go electronically (without clearinghouse rejects/errors) , go through the PWK options with Novitas.
I use this when I need to submit records for unlisted CPT codes.
Go to the Novitas website & search PWK. Here is the link:
http://www.novitas-solutions.com/we...1259384625681000&_adf.ctrl-state=tziq1b4g2_67

It will give you instructions on where (field/loops..) to "flag" your electronic claim to tell them that you are submitting supporting documents & how you are submitting (fax, mail...)
There is a link for the fax cover sheet to download & fill out. You can just fax the primary & secondary EOBs with that cover sheet.

 

[nbohm]

Thanks for your response. I did see some info on the PWK but will have to check further on the secondary guidelines for claim filing electronically to see why this is not working for us.

Looks like we will have to try these other things. Was hoping someone had found the solution so again appreciate your time and response of other options.