Riverbend

Miscellaneous FAQ

How do I verify HMO, Hospice or Home Health for a beneficiary?

A facility can verify HMO, Hospice or Home Health status by accessing the Common Working File (CWF). You may access the CWF by entering HIQA on Direct Data Entry (DDE), instead of FSS0. A screen will display prompting you to enter patient specific information into the appropriate fields. Once the fields are populated press enter. The CWF will display the beneficiary information. When a claim is submitted to the CWF the beneficiary file will be updated. (7/6/2007)

When mailing medical Records to RGBA what address should be used?

Medicare Medical Review Department
P.O. Box 6098
Chattanooga, TN 37401-6098 (7/6/2007)

What is the retention period for claims Returned to Provider (RTP)?

As of May 18, 2001, Riverbend GBA revised the retention period for claims RTP'd to providers to 60 days. RTP histories older than 60 days are purged from the system. (7/6/2007)

How can I obtain Medi letters and other information if my facility does not have Internet access?

If you do not have Internet access, you should determine if someone within your facility has Internet access. (7/6/2007)

Reason codes 30940 and 30941 indicate the provider is submitting an adjustment or cancel against a medically denied claim.

Beginning in 2002 these reason codes did prevent providers from submitting adjustments/cancels on a medically denied claim via DDE. However, Riverbend made changes to the system to allow these adjustments/cancels into the system for manual review. The adjustments/cancels will suspend to status/location SM1501 when submitted. (7/6/2007)

Providers are sending information proving the date of death on the system is incorrect, but are told there is nothing Riverbend can do to correct the issue. There are situations where the claim was submitted with a 20 discharge status rather than an 02, but it is not that provider's claim. SSA will not correct dates of death based on provider information, and beneficiary has no family members or is not mentally capable of going to SSA on their own. What can Riverbend do to assist the providers in this case?

If your facility is unable to process a claim due to date of death incorrectly posted to the CWF (Common Working File) contact our provider line and the Customer Service Representative will make every attempt to contact the previous facility to correct the error. Allow time for the claim to process and contact the provider line again to make sure the error has been corrected before submitting your claim. (7/6/2007)

Where can I find training for my office staff on Medicare requirements?

CMS provides the Medicare Learning Network which will assist you and your office with proper submission of Medicare claims through a variety of educational materials and resources. These include: Quick Reference Guides for "hot topics", computer-based educational modules and products, basics of coding and claims payment, resident training information, and a website where you can order, free of charge, many Medicare educational products. (7/6/2007)

Our Medicare claim has been returned to our facility for correction with reason code 11801. What do we need to do to correct this problem?

The claim has received the reason code 11801 due to the source of admission is blank on the claim. If your bill type is 13X, 14X or 83X the source of admission must equal a number from 1 thru 8. If you are a DDE user you can access the claim in RTP and add the source of admission to the claim and press F9 to activate the claim. If you use PC-ACE you will need to submit a corrected claim. (7/6/2007)

Our facility submitted a claim that was rejected. The claim is appropriate for payment, and as a result we submitted another claim. However, the claim we have submitted has rejected for duplication. What do we need to do in order to process the claim?

Paid and rejected claims post to the Common Working File (CWF) database. Therefore, submitting a second claim will create a duplicate. It is necessary to activate the original rejected claim. If you are a DDE user you will select 03 Claims Correction, then select claims adjustment. You will need to select the appropriate TOB, e.g. inpatient 20, outpatient 21. After the selection you will key in the beneficiary's HIC number and tab to the S/LOC and change the "P" to "R" and change the type of bill if necessary. Press the enter key to pull up the claim. The claim will be displayed on the screen and your facility can make the appropriate corrections and press F9 to activate the claim. (7/6/2007)

What are the regulations for timely filing?

Medi letter 1427-03 appends Program Memorandum A-03-34 which states: "Federal regulations define the timely filing period for Medicare claims relative to the date a service is provided. Services provided in the first 3 quarters of a calendar year are considered timely if received by December 31 of the year following the service year. Services provided in the last quarter of a calendar year are considered timely if received by December 31 of the second year following the service year." (7/6/2007)

• For services rendered between: Oct. 1, 2000 & Sept. 30, 2001 - Your claim must be submitted by: Dec. 31, 2002
• For services rendered between: Oct. 1, 2001 & Sept. 30, 2002 - Your claim must be submitted by: Dec. 31, 2003