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pcossentino

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I have a problem that I'm hoping you can help me with. We filed 300 claims to Medicare for the new doc in early Feb. First, I submitted 15 as a test batch and when that went through our clearinghouse (Gateway) and they were accepted by the payer and I went ahead and released the rest. I've started to get remittance and they are all zero payment !! Yesterday we called MDC and it turns out the Dr. facility set-up in our EHR does not have the full zip code it just has (79902) and Medicare needs the full zip. We would have picked it up with the first 15 test claims but turns out Gateway default auto populates the rest of the zip with 9998 if it is missing so all the claims went through..... my heart sank ... so now what? Medicare says they have to be completely new (not copied or replacement) and the rep we spoke to made it sound like we needed to drop them to paper?? We are talking 300 claims !! I'm not sure what to do because I don’t want them denied again.

What do you think? How should we handle this re-file? I really want to do it electronically - so you with experience think we can do?

Thanks for your help !
 
You should be able to correct the zip code in the master file of your practice management software. Then you should be able to do an electronic re-file of the denied claims by date range. Our software has options for date range constraints, insurance type, etc, in the module where we file the claims, so there should be some options like this that will allow for a complete electronic re-file of the claims in question.

You will want to research all possible electronic options even if you have to call your IT people for assistance as you do not want to drop them to paper.

I hope this information is helpful to you.
 
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