Medicaid claims may be replaced directly from Barnestorm. Each Medicaid claim sent for each patient has a unique identifying number, called an ICN.
You need to create a replacement claim when the original claim that was transmitted was incorrect due to missing information or incorrect information (examples: the rates have increased and were billed at a lower rate previously, the claim did not include a visit that was added to the system after the claim was sent, or the number of hours billed was incorrect).
IMPORTANT: if the claim rejected and did not pay, then just build a new claim and send it--replacement is not needed when the claim doesn't pay at all.
Here are the steps to replace a Medicaid claim:
Verify ICN Information
Go to Accounts Receivable > ICN Edit.
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Enter the patient's chart number.
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If the patient has more than one payer, select the payer.
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The ICNs are listed on the right, showing From Date, Through Date, Paid Date, and ICN number. Determine which ICN needs to be replaced based on the dates. Make a note of the from and through dates.
If the ICN you need to replace is not there, you can enter it manually using these steps:
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Click the Add a New ICN Entry button.
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Enter the information from your paper copy of the remittance advice: payment date, from date, through date, and ICN number.
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Click the Save button.
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Your ICN entry will now appear in the list; make a note of the from and through dates and continue the steps in this process.
Create Replacement Claim
Note: You can create multiple claims in one batch. The entire batch will need to have valid ICN's in the system and no existing filename. Otherwise, a batch will not generate.
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Go to Billing > All Other Billing
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Enter the From Date and Thru Date that were used to create the original claims.
If any specific Programs and Payers were used to select the patients, enter those again as well.
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NOTE: The software searches for the matching ICN by matching the chart#, Program, Payer, From and Thru dates.
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Enter the patient chart number(s). Exclude any patients that didn't pay on the original claim.
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Select Prepare Charges For Billing.
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****Check the box beside Send as Replacement Claims **** THIS STEP IS IMPORTANT****
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Create HIPAA Tx. Any claims that do not have a matching ICN will be excluded from the replacement batch.
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Go back to Accounts Receivable > ICN Edit. You should see the batch number beside of the ICN number you just created a claim for.
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Transmit to Medicaid as normal--the transmission process is exactly the same for a replacement claim as for a regular claim.