Embed Size (px)
Citation preview
Add TitleClaim Status
January 18, 2017
Agenda
Explanation of the Washington Publishing Company
(WPC) website
Claim Adjustment Reason Codes (CARC)
Remittance Advice Remark Codes (RARC)
How to Claim Status
Downloading your Remittance Advice (RA) from
CHAMPS
Downloading a Claims Report from CHAMPS
Submitting a 276 Inquiry & receiving a 277 Response
Receiving an Electronic 835 File
Upcoming Trainings
Washington Publishing Company
Claim Adjustment Reason Codes (CARC) Determine why a claim or service line was paid
differently than it was billed.
Examples of commonly used CARC Codes: 1 – Deductible Amount
2 – Coinsurance Amount
3 – Co-payment Amount
45 – Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
58 – Treatment was deemed by the payer to have been rendered in an inappropriate of invalid place of service.
Washington Publishing Company
Remittance Advice Remark Codes (RARC)
Additional explanation for an adjustment already described by a CARC
Examples of RARC Codes:
Supplemental:
N219 – Payment based on previous payer’s allowed amount.
N290 – Missing/incomplete/invalid rendering provider primary identifier.
Informational:
M9 – Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.
N109 – Alert: This claim/service was chosen for complex review.
How to Claim Status
Downloading your Remittance Advice (RA)
Claim Status Response
The below is a similar example of an email that
may be sent to providers or billing agents asking
for basic claim status:
Downloading your Remittance Advice (RA)
Log into MILogin
Click on CHAMPS
Go to My Inbox tab
Select Archived Documents
Under Document Type: Select Medicaid Payments paper RA
Click Go
Find the Scanned Date that corresponds to your pay cycle date/EFT/warrant date.
Click on the Paper RA hyperlink
The first page of a paper RA , displayed in PDF format
The second page of a paper RA
Please Note: Suspended
Claims and MDHHS Proprietary
Codes will not be reported on
the Remittance Advice
Total Number of Credited Claims
Total Number of Gross Adjustments
Total Number of Rejected Claims
Total Number of Paid Claims
The third page of a paper RA
Explanation of the third page of a paper RA
Downloading your Remittance Advice (RA) Links
For a step by step visual aid on how to retrieve an
RA via CHAMPS:
Within the CHAMPS Navigation training , click on
the contents page My Inbox functions (slides 8-28 )
hyperlink
For other helpful links: CHAMPS Quick Links
How to Claim Status
Downloading a Claims Report
Downloading a Claims Report
Log into MILogin
Click on CHAMPS
Go to Claims tab
Under Inquire Claims: Select Claim Inquiry
Select your Filter By criteria Input the % sign to act as a wild card
In the following example we have used, From/To Dates, and entered the % for Beneficiary ID and Reason Code.
Click Go
Click SaveToXLS to export to Microsoft Excel
After the query has ran and returned results click the SaveToXLS button to allow
the query to open within a Microsoft Excel worksheet
The query information will then be opened and displayed within Microsoft Excel
Downloading a Claims Report Links
For a step by step visual aid on how to download
a claims report via CHAMPS:
Within the CHAMPS Navigation training click on the
contents page Claim inquire (slides 85-91) hyperlink
For other helpful links: CHAMPS Quick Links
How to Claim Status
Submitting a 276 Inquiry & Receiving a 277 Response
Submitting a 276 Inquiry & Receiving a 277 Response
The 276 is used to specifically inquire about the
status of one or more claims submitted to a payer
for adjudication.
The 277 is the payer’s response to the 276
request.
When the submitter’s request is processed
successfully without errors, the 277 returns a
status on all claims that meet the criteria supplied
in the corresponding 276.
Submitting a 276 Inquiry & Receiving a 277 Response
For further information in regards to electronic
files please visit the Trading Partners Webpage
Companion Guide for submitting a 276 Inquiry
and receiving a 277 Response
For other helpful links: CHAMPS Quick Links
How to Claim Status
Receiving an Electronic 835 File
Receiving an Electronic 835 File
Two ways to receive electronic 835 file:
First, by associating to a billing agent, who may or
may not be the provider themselves and then,
authorizing the billing agent to receive an electronic
835 file.
Second, only if a provider does not have a billing
agent. The provider can go into CHAMPS under the
Claims tab, click on the RA list and using the filter
by option. Click on the RA you are looking for and
the 835 file information will be at the top right of the
screen.
Receiving an Electronic 835 File Links
For further information in regards to electronic
files please visit the Trading Partners Webpage
Companion Guide for receiving an electronic 835
file
Further instructions on how to associate to a
billing agent
For other helpful links: CHAMPS Quick Links
Upcoming Trainings
2017
Upcoming Trainings January 19, 2017
Document Management Portal Virtual Training (10:00-11:00)
January 26, 2017 Timely Filing Virtual Training (10:00-11:00)
February 9, 2017 CHAMPS Navigation Virtual Training (10:00-11:00)
March 2, 2017 Determining Eligibility Virtual Training (10:00-11:00)
To see more trainings please visit the Medicaid Provider Trainings site.
Recordings of past presented trainings are also available and updated frequently on the Medicaid Provider Training site.
If you have suggestions for trainings please email: [email protected]
Provider Resources
MDHHS website: www.michigan.gov/medicaidproviders
We continue to update our Provider Resources, just click on the links below: Listserv Instructions
Medicaid Alerts and Biller “B” Aware
Quick Reference Guides
Update Other Insurance NOW!
Medicaid Provider Training Sessions
Provider Support: [email protected] or 1-800-292-2550
Thank you for participating in the Michigan Medicaid Program
