Posted by Behavioral Health Billing Solutions, LLC.
So let’s spend some time and talk about how you are testing for the Ohio BH Redesign.
1. Are you testing through a clearing house? If so, are you getting 277U claims response file AND an 835 remittance in response to your test file?
2. If you are testing through a Trading Partner, other than your agency, are you able to send test files? And are you receiving your 277U claims response file and 835 remittance file?
3, Are you your own Trading Partner? If so, are you reviewing your response files?
3. If you are receiving your response files, are you reading them? A 277U claims response file gives you Ohio’s reason’s to denials of a claim. An 835 remittance file gives you an adjudication response but at a national level. You need information from both to understand why your claim denied.
I test for a number of clients on different software programs. I rely on the 277 and 835 to tell me what is wrong. Recently, I have had different agencies report that their claims were accepted and paid through a clearinghouse but when I sent the file direct to Medicaid, I found out the claims were adjudicated (accepted) but were not paid due to various reasons.
This weekend I sent several test files but one, in particular, I looked at, and I wanted to review what results I got.
What does that show us? An accepted claim does not mean your claim will be paid as expected. I had several claims reduced due to the provider billing.
To summarize even though it’s a Saturday OSU game day and my grandson’s first birthday, I reviewed my test file responses….if you aren’t looking and analyzing ALL your response files, your reimbursement may be much different than expected.
As always, I strongly recommend EMS Healthcare Informatics to assist you with tools to interpret your files. If you need additional help, Behavioral Health Billing Solutions is always here to provide the technical assistance you may need.
20 Days left to test. 5 days left to Beta Test. Make use of this time frame.