MA denials for missing other plan information

Are you talking about MN MA?  I haven't seen it yet with MN MA though for our claims, but maybe we just haven't had a client with that combo just yet.  But we had this issue with our ND MA claims and it ended up that ND MA changed to where if the client had Medicare or a Medicare Advantage plan as primary, when billing to ND MA as secondary they wanted the claim to come through with an MB for the Claim Filing Indicator of which Procentive had to create for us.    So that might be the same thing here with MN MA possibly. 

Yes, us too with MN MA and Medicare or Medicare Advantage plan - have no idea why and our COB is correct as well.      Probably need to open a case with Procentive to see if we need a different modifier.

So many Secondary claim glitches this year. I am also getting these denials. side note but When working with Procentive recently on another related type glitch, I was told that you NO LONGER have to manually poplulate the svd field. That glitch is fixed. 

Update- I am still getting denials from MA for a perfectly sent 2ndary claim. If you look at the claim data of the MA claim, says: Payer Order- P. 

This is a glitch. It should say S. 

That is why the primary COB isn't traveling. This needs to be fixed. Have a ticket in to Procentive. 

Another thing I learned is that the secondary insurance must now have the True secondary field set to Yes. 

And send other insurance info set to yes. 

I have never had to do this in the past to bill secondary but now you do. I think that solved my MA secondary issue. 

Wow, having to change those settings for every secondary MA insurance client, is going to be so annoying and time consuming.  Like what the heck happened that we now have to do that when we've never had to do that before. 

I know. And I'm having trouble on repl claims I'm doing after I changed the settings. It's like the claim is locked in as a primary claim and won't go out as a secondary. I can't send a new claim b/c it gets denied as a dupe. (For non-MA payer). 

I called MN MA and the rep walked me through what has to happen on the MNIts site to correct it.   Apparently they need the primary payer control number for Medicare (claim number) entered manually on each of those claims that are denied for missing other payer information.  Same goes for Medicare Advantage plans, but on those they need the actual COB entered and not the claim number.  Go to MNIts, look up the claim, then select 'copy' and keep clicking through until you reach the section that has a box for "Other Payer's Claim Control Number" and copy the claim number from straight Medicare.  It's the forth screen in in the middle.  Save all the changes and then 'continue' until the very last section then check the 'other payer' tab and see if the cob is correct or if you need to edit.   For the Advantage plan you have to enter all the COB codes and amounts, etc.  At the very end you select "save/view lines", then 'submit'.   Hard to explain without doing screen shots, but...HIPPA.  I've done this on all those denials and we are starting to get paid for them.  Tedious.  It's always something.  The MA rep was great though and it was a huge relief to know we could do SOMETHING to get paid.  lol

Thanks for the info. Is this something Procentive can fix on their end? Shouldn't their software be abe to bill a secondary after primary Medicare plan? 

It does send to secondary - it is the secondary (specifically MA) that is somehow not receiving all the cob info.  Don't know why - Procentive says cob is traveling on the claim - and some of it gets through, but not the original claim number in the case of MA - or in the case of other Medicare Advantage plans, the actual cob doesn't travel except for the paid amount usually.  NO IDEA why.  Ugh.  

Oh, ok, thanks again. Need to do t his process for a client today. Ugh!

Good luck!!

Now getting dual payments on one client's MA as secondary claims - Medicare Primary.  Wondering if the 'crossover' was delayed, we send an electronic invoice to MA anyway, but you would think they would realize that it is a dual payment, especially on the same remit!  Wish they would pull themselves together.  

Thanks for the update. I never send electronic claims to a crossover- for this reason. I've had dupe payments!