Wiki Medicare wrap around payments

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You will need to get approval from your MAC before being able to bill.
you need to submit reports showing average payment for certain CPT codes per Med Advantage carrier and a copy of your contracts.
your MAC should be able to give you contact information and what exactly thy require.
 
Hi ntreber ,

Thanks for that inform. We have made it that far. However, we are having trouble submitting the claims. We are a Federally Qualified Health Center (FQHC), We bill differently from private physician offices. We bill Medicare NGS on UB04 with bill type 771, and Revenue code 0519 for the wrap around payment. but this is the error message that we have been receiving:

THE PAYOR CODE MUST BE EQUAL TO A, B, C, D, E, F, G, H, I, OR Z,
OR
PAYER ID IS EQUAL TO I, VALUE CODE 42 IS PRESENT, AND THE BILL TYEPE IS NOT 11X, 18X, 21X, OR 41X.
VALID PAYER CODES:
A = WORKING AGED-EGHP
B=END STATE RENAL -EGHP
D= MED PAY/NO FAULT INS
E= WORKER COMPENSATION
F = PHS
G= DISABILITY - LGHP
H= BLACK LUNG
L = LIABILITY
C= CONDITIONAL ( ANY MSP VALUE CODE $0.00 IS REQUIRED)
Z = MEDICARE PRIMARY ( NO MSP VALUE CODE)
* EFFECTIVE 10/01/2013 CONTRACTORS CAN NO LONGER CREATED VETERAN AFFAIRS (VA) "I" RECORDS.
 
I am also FQHC. You are submitting with PPS code and CPT code, are you also showing payment from Med Adv carrier?
 
Not exactly, we submit our claims electronically through eclinicalworks. The payment is not showed on the ub04 when it gets to the medicare NGS . We send our office visit and the pps rate code to Medicare NGS.
 
Newbie

ntreber said:
I am also FQHC. You are submitting with PPS code and CPT code, are you also showing payment from Med Adv carrier?
Click to expand...

I have been tasked to file wrap payments for the first time in this FQ. I am curious how exactly you submit your claims, do you create a new claim within your pm to send out?

I appreciate any and all information you have, thank you
 
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