Members Encouraged to Check January Vendor
All members should check their January vendors, for services rendered in December, to fully analyze the payments they received. Please take note of probable overpayments that are due to patient liability not being deducted from your room and board claims, and this money will need to be returned to Medicaid. As reported in last Friday's News Bites, members had reported to OHCA that their December room and board claims, billed to Medicaid the first week of January, were paid without patient liability deducted. We believe this has occurred because software vendors and clearinghouses were not informed by ODJFS of billing changes, related to reporting patient liability and billing services dates, were being imposed January 1, 2012, based on HIPAA Version 5010 Ohio provisions. Trading partners did not realize these changes until OHCA sent out a bulletin Monday morning January 9, which we received from ODJFS Friday afternoon January 6. Currently OHCA has requested from ODJFS further clarification to Ohio trading partners related to these billing changes for many have reported to OHCA that they still need more information to ensure compliance. While secondary claims are just now hitting for some of our members, we do anticipate problems with Medicare secondary claims not paying correctly as well.