Clearinghouse Issues with Chiropractic Demonstration
PS has received inquiries over the last month in which participating chiropractic demonstration providers are experiencing 'rejections' when more than two modifiers are submitted on a single detail line for electronic claims.
The billing issues include instances in which chiropractic demonstration claims require more than two modifiers be submitted on the claim. Many providers have commented that they are receiving Medicare rejections because WPS will not accept more than two modifiers billed on a single detail line of service. The Medicare processing system (Multi-Carrier System (MCS)) will accept up to four (4) modifiers per detail line. We have found that the billing issues are within the Clearinghouse software, not Medicare processing.
Our Electronic Data Interchange (EDI) department has heard from some providers that the Clearinghouse is not able to accommodate the demonstration claims for multiple modifiers. It isn't always clear as to whether or not the provider's software cannot accommodate the demonstration information or whether the Clearinghouse cannot accommodate the demonstration information. It appears more often than not, a Clearinghouse issue. In these instances, the Clearinghouse is not HIPAA compliant. In some cases, providers may use a Clearinghouse to achieve HIPAA compliance; that is, they may send a non-standard claim format (i.e. non-837 4010A1 format) to the clearinghouse and the clearinghouse may convert the format to the HIPAA format and send the claim to the respective payer (i.e., Medicare). We are instructing providers to check with their software vendors to ensure the chiropractic demonstration information is in the proper electronic position upon submission; and then to check with the Clearinghouse to see if they are receiving the correct formats, and then transferring the correct information in the appropriate positions to Medicare. Providers should be questioning Clearinghouses who cannot accommodate multiple modifiers as to when they will be ready to do so.
In the meantime, providers do have the option of utilizing Medicare's free billing software, PC-Ace Pro32 to accommodate their demonstration claims. PC-Ace Pro32 is a "stand alone" software package that creates a patient database and allows your office to electronically submit most WPS commercial, Medicare Part B, and Tricare physician claims electronically. Your office could benefit from; 1)Faster claim payment, 2)Lower administrative costs, 3)Immediate feedback on claim status information, and 4)Greater patient satisfaction. PC-Ace has many built in system features to lighten your office's workload. The software provides you with the ability to enter patient information, claim information, procedure file information, and create summary reports of the claims you submit electronically.
For more information on the software, please contact the WPS EDI Hotline at:
Wisconsin, Illinois, Michigan
877-567-7261
Minnesota
952-885-2811
952-885-2881
952-885-2882
Or visit our website, http://www.wpsic.com/edi/pcacepro32.shtml
