Sometimes claim items are billed to the wrong payer because the wrong payer was originally selected for a client, which unfortunately has become much more common due to the constantly fluctuating nature of client eligibility with Oklahoma Managed Care Organization payers. OK MCO payers have a nasty habit of dropping client eligibility for short periods when then become eligible for OK Medicaid during those periods. OK Medicaid has a nasty habit of initially paying claims that should be paid to one of the MCO payers and then recouping the money later, sometimes months later when it is too late to rebill claims to the correct payer.  Therefore it is incredibly important that client payer eligibility information be verified manually when adding a new client, and for OKHCA payers that the client's payer information be set up correctly so that the client's payer information is automatically updated when the client's MCO payer status changes. Below are the steps necessary to properly setup client payer information and resubmit previous billing that has gone to one payer when it should have gone to a different payer. These steps have some specific information for OKHCA payers but the basic concepts can be used with any payer.

1. Verify Eligibility.  This is accomplished differently for different payers, but for OKHCA payers begin by logging into the OKHCA website to verify client eligibility. You will need to note if they are eligible for OKHCA payer like OK Medicaid, which MCO payer(s) (if any) they are eligible for, and what the effective and expires dates are for each payer. On the OKHCA website you can verify eligibility up to a year in the past, and it is best to use the client's Medicaid number to verify eligibility, rather than their name. Occasionally the client name or client ID changes, and the most recent data may not be displayed if the old name or ID is used. 

2. Match up Client Payer Information. Open the client's information page in ChartCaddy, then scroll to the bottom and locate the section for Client Payers. Add or update payer lines to the client as necessary to make sure all dates of eligibility for each payer are present. If there are multiple breaks in eligibility, you will need to add a separate payer line for each payer eligibility span.

3. Check the plan. Return to the client's chart by clicking the View Chart button, then scroll to the bottom of the page where the Chart Authorizations section is displayed. This gives a chronological list of the most recent authorizations, and you can quickly go to the client's most recent plan by single-clicking the top line in that small list, then click the View Plan button just below and to the left. If the new payer you need to rebill claims to is not listed as the Main Payer, then change the Main Payer to the new payer and click the Save button. This will duplicate all services on the Plan Goals page for the new payer, which eliminates the need to do a Service Plan Modification. It is a good idea to explore the authorization list at the bottom of the chart to verify that the system has allocated units for the new payer.

4. Update the chart items. Return to the client's chart and single click the chart item that need to be resubmitted to the new payer. You can hold down the Control key (or the Command Key, if you are using an Apple product) to select more than one chart item at the same time. Use the drop down menu directly below the Export Selected button to select "Update Payer", then click the Update button. This will force the chart item to recheck the plan and the client payer page to detect and apply changes to the payer(s) that should be billed. Verify that the change has taken place successfully when the process is finished by double-clicking each chart item to open it. It will list the payer information in the lower section of the chart item. The payer you want to resubmit that chart item to first must be present and state "Is Active: Yes" on the chart item, and all other payers will state "Is Active: No". 

5. Resubmit the claims. Use the Claim Items report to locate the claim items that need to be resubmitted from the old payer to the new payer for the client. Select the claim items, then use the drop down menu in the lower left corner and choose "Next Payer", then click Update. This will write off the remaining due amount of the original claim, mark it as defunct, and then create a new claim item for the new payer. If the text in the progress bar that appears at the top of the page when you do this step turns red, one or more claims could not be rebilled. Allow the process to finish, then you can either click View Results and it will tell you which items failed, or you can simply click the "Search" button again on that page to refresh the page and see which results are still there. Troubleshoot why that item failed by repeating all steps outlined in this article.