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TELECOM-Medicare
Menu Path: TELECOM/Medicare

• Extract Claims to Transmit

• Transmit Claims to Medicare

• Reset Claims Marked for Transmission

• Reset Date Filed of Claims Filed on Date

• Print List of Claims Electronically Filed on Date

• Receive Claim Status From Medicare

• Set Date Filed for Claims Marked for Transmission

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Extract Claims to Transmit
The criteria for extracting are:

• Company screen flag says Y(es) electronic claims used to file Medicare

• Invoice Medicare Paycode Window says File By MODEM

• Invoice Medicare Paycode Window Paid/Rejected flag is blank

• At least one supply has Medicare Allowed Amount not zero in the supply file

• Alabama Medicare -- Diagnoses (ICD Codes) with E-codes will not be transmitted

These claims are extracted: Medicare primary, Medicaid secondary to Medicare, MEDIGAP secondary insurance crossovers, and Insurance primary with the same insurance code as the Medicare carrier code in company screen 1.  Claims are extracted and formatted for transmission, and a report is printed for those claims.  These invoices are locked out for editing, until either transmitted or unmarked for transmission

Transmit Claims to Medicare
For claims that were previously extracted and marked for transmission, the sequence is this:

1. The Medicare computer is dialed and connected with your MODEM via login codes and handshaking.

2. Files are transmitted with the MODEMS adjusting transmission rates to suit the telephone lines, checking transmission errors, retransmitting, etc. transparent to you the user.

3. Upon successful transmission, the Medicare computer acknowledges (ACK) successful reception to the data or not successful (NAK)

4. Your computer will hang up the phone line

5. Your computer will print out a transmission report if and only if transmission ACK is received from Medicare

6. Each invoice will have both the Medicare date-filed field set to today's date, as well as each secondary crossover claim.

Reset Claims Marked for Transmission
Claims that have been extracted will be marked for transmission.  This menu selection un-does the extraction, in other words this is the opposite of extract.

Reset Date Filed of Claims Filed on Date
If for some reason you have to re-transmit claims for a specific date, this menu selection will allow you to enter the date, after which the date filed in the invoices for that date only will be reset-- ONLY FOR ELECTRONIC CLAIMS -- Paper claims are unaffected.  This way you can extract and transmit again.

Print List of Claims Electronically Filed on Date
This is the same report as printed after successful transmission.

Receive Claim Status From Medicare
Not activated in all states.   If you leave the date blank, a report will come back from Medicare with dates for which audit trails are available.

Set Date Filed for Claims Marked for Transmission
If claims are inadvertently reset, this will off set that possibility