WinCare User Guide

Master Files 409

3. Always bill Medicaid recipient liability in full, even if no

Medicaid patient days are billed and even if no Medicare Part A

Copay days are billed to Medicaid. Medicaid must be a secondary or tertiary payor.

Advanced Medicaid Recipient Liability can be pre-billed when

Medicaid is the secondary payor by setting the Medicaid Billing

Rules as follows: Check "Pre-Bill Monthly Deductible to Private

Pay" and check "Always Bill Medicaid Recipient Liability in

Full,..."

UB Claim Options:

UB Claim Options and what they do

Use the CPT code if one is given, otherwise show the rate.

If the Revenue code is >= 200 and <400, then :

1. without this option neither rate nor units will show.

2. with this option, if there is a CPT code, it will be shown, otherwise, the rate will be shown

If the Revenue code is < 200 or >= 400 then no matter how this option is set, the CPT will be used over the rate if it is specified.

Detail all Ancillaries on Claim

Unless some kind of detail option is set, normally the Claim will show a summary be grouping all the ancillary by CMS Rev Code, reporting one line with the total of all the charges for the CMS

Rev code. Eg: 0300 LAB 195.00