Medicare - Overview
Welcome to the MediRecords Medicare Tutorial.
This article has been written to give new users an informative overview of the various aspects of Medicare Claiming within MediRecords. In this article, you will learn how configure your software to setup Medicare claiming your practice, how to use OPV to verify your patient's identity with Medicare, how to process patient claims, gap claims, bulk billing and how to manage your practice's Medicare claiming account.
Part 1: First Time Setup
Before you can use Medicare Online Claiming at your practice, you will need to migrate your providers to your new Minor Site ID, upload your Medicare Sites Certificates into MediRecords and configure the Medicare settings for your practice and providers.
If you are a new practice or don't already have a Medicare PKI Site Certificate, Click Here to download the applications form from the Human Services website to apply for one.
Migrate existing providers to your new Minor Site ID
To migrate providers to your new Minor Site ID (known in MediRecords as Minor Customer ID), you will need to download and fill out an application form from the Medicare website.
Before you do this, you will need to make note of your Minor Site ID, as it required on the application.
To locate your Minor Site ID, navigate to the top of the page and click More to reveal a drop-down list.
Click Settings to open the settings menu.
Click Configuration Settings.
On the following page, click the Name of the Practice to open the configuration settings. (In this example, the name of the practice is MediRecords Admin).
Click Claiming, and then write down your Location Code (this is your Minor Site ID).
You now need to download the Medicare Online Claiming form for linking provider numbers to a Minor Site ID.
Click here to download the application form.
At the top of the form, you will need to make note of your old Minor Site ID, and the date you want your new MediRecords Minor Site ID to take effect.
Please make the Effective Date at least 5 days after the date you switch over to MediRecords (this will not affect new Medicare claims).
Example:
There is only room for six provider names on the form. If you are migrating more than six providers, you will need to fill out a second form.
Please allow at least 5 business days for Medicare to process the your current claims, and continue downloading your Processing and Payment Reports from your old clinical software package.
All new claims (Bulk Bill & Patient Claims) can be stored in MediRecords, and transmitted to Medicare once the new Minor Site ID has taken effect.
Here's how you can locate your old Minor Site ID in your existing clinical software package -
Best Practice:
Click Setup -> Configuration -> Online Claiming
Medical Director 3:
Click Setup -> Global Settings -> Bulk Billing
If you have applied for new Medicare Site Certificates, wait for them to arrive by mail before proceeding to the next step. However if you are using your existing certificates, please proceed to the next step.
Upload Medicare Certificates into MediRecords
In step two, you will need to upload your Medicare Sites Certificates into MediRecords.
To do this, navigate to the top of the page and click More to reveal a drop-down list.
Click Settings to open the settings menu.
Click Configuration Settings.
On the following page, click the Name of the Practice to open the configuration settings. (In this example, the name of the practice is MediRecords Admin).
Click Claiming to open the claiming configuration form.
Click Medicare Pass-Phrase and type in your Medicare pass-phase (known as a PIC code) that you would have received in a letter after you received your certificates.
Navigate to P12 Certificate File (encrypt), and click Select File to open a file explorer window.
Navigate to the folder where your Medicare certificates are located, and select the file called fac_encrypt.p12 for upload.
Click Upload File to upload the certificate.
Once the certificate has been uploaded, there will be a message "100% done" next to it.
Navigate to P12 Certificate File (sign), and click Select File to open a file explorer window.
Navigate to the folder where your Medicare certificates are located, and select the file called fac_sign.p12 for upload.
Click Upload File to upload the certificate.
Once the certificate has been uploaded, there will be a message "100% done" next to it.
Click Activate Medicare PCS to reveal a drop-down list, and click Yes (this activates Patient Claims Store & Forward).
Check the form, and make sure you have filled in data for the Medicare Pass-Phrase, uploaded certificates for P12 Certificate File (encrypt) and P12 Certificate File (sign), and Activate Medicare PCS is set to Yes.
*NOTE: Please wait at least two weeks before automating claims and reports.
Once you have completed the check, click Save to apply the changes.
Once the claiming configuration has been saved, the system will automatically populate the Medicare - Sender field with the sender information. The Sender information is stored in your Medicare Certificate.
Please allow 15 to 30 minutes for activation of your certificates to take effect on the Medicare server. To verify that your certificates have been activated correctly, run a patient OPV check and act accordingly to the prompt.
Configure individual Medicare profiles for providers
The final step for setting up Medicare claiming is to configure individual Medicare profiles for your providers.
The default Provider Type for providers is General (General Practice). You only need to complete this step if the provider is a Specialist or Allied Health, as this will need to be flagged on their Medicare Claims.
To configure a provider, click More at the top of the page, and then click Settings.
Click Subscription Details.
Click Users to open the list of users registered on your subscription.
To configure a provider, click the Tick-box next to the name to reveal a list of options. Click More to reveal a drop-down list, and then click Configure.
Click Invoices, and navigate to bottom of the form. Click Medicare Provider Type, and select General, Specialist or Allied.
NOTE: For Specialists to have their claims assessed correctly, be sure to configure both your Medicare Provider Type and set Include referral for Medicare Billing to YES. If this is not configured accordingly, your claims may be rejected.
Click Save to apply the changes.
Once this last step has been completed, your practice should be ready to start submitting Medicare claims online.
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