Many of our customers have called us asking if they can
send their claims electronically to Railroad Medicare. It seems Railroad
Medicare released a letter to all of their current providers telling
them that they will no longer accept claims via paper as of July of 2005.
What the letter fails to mention is that almost all of the recipients
of the letter either send so few claims on paper to Railroad Medicare,
or have so few employees, that this requirement does not apply to them.
Currently, Stephens & Associates does not have a “Carrier Module” for
Railroad Medicare. This is a function of demand, as until this letter
was released, none of our clients have ever expressed any desire to send
claims electronically to Railroad Medicare.
So what options do you have?
Option 1: Go Gold
Users of our Gold Validator version have the ability to send claims
to ANY HIPAA compliant carrier, which would include Railroad Medicare.
This version of our program allows you to use a step by step “wizard” to
configure any carrier and immediately begin sending them claims.
Option 2: Opt Out
Since almost all of the recipients of the letter qualify for an exemption,
you can choose not to send them claims at all
Option 3: Go THIN
If you already submit commercial claims to THIN, or if you have at
least a Silver version of our Validator program, you may submit your
Railroad Medicare claims to THIN as long as you continue to submit
more “commercial” claims in any given month than “government” claims.
Option 4: Wait
Our Validator Silver licensing is very generous, and allows you to
have all carrier modules that are appropriate for use with your state.
As a result of our Gold Validator users, new carriers are added to
our list all of the time, and if that carrier is appropriate for your
state, we will allow you to add and use it at no additional charge.
If you read our last newsletter,
you should already know that Blue Shield of California is now accepting
claim files in the HIPPA-compliant
ANSI format. For those of you still submitting in the old NSF format
you will need to switch your claims to the ANSI format as soon as possible
to avoid a possible cutoff in payments from Blue Shield of CA. The great
news is that you will not even have to test with Blue Shield. Stephens & Associates’ Validator
has been approved for production for all submitters currently submitting,
therefore when you send with the Validator software you can go straight
to production mode and have no delays in getting your claims paid.
Blue Shield will be updating your profiles to make this process as smooth
as possible. If you do have any difficulty you will simply need to contact
Kelli Gonczeruk at Blue Shield (530-351-6058) and advise her that you
use the Validator software and she will then make sure your profile is
updated so that you will be able to send you claims right away.
