Payer IDs

Use the Payer ID DMERC for all DME Claims.

• The Claims are routed in the DME system based on the address on the Claim in the Subscriber Loop.

CFI

The Claim Filing Indicator must be MB.

POS

The Place of Service is 12, and when used, the Patient's Address is populated on the Claim instead of a practice address. 

• If you have made a change to the Place of Service, check the lines to make sure they have been updated as well.

Patient's Address

The Patient's Address must be the same as the Medicare database. 

• On the Eligibility Report, you can view the Patient's Address that Medicare has on file. 

• You may need to temporarily change the Patient's Address in the System, send the Claim to Medicare DME, and return to the Patient and change the Address back to the previous one if it is correct.

Medicare and Medicaid DME Claims

For Medicare and some Medicaid, DME Claims must be sent to a different Payer. 

• The DME payer should be set up in the Insurance Library as a unique Insurance.
• You need to add the DME policy to an Active Insurance Profile for the patient.

Add DME to an Active Insurance Profile

1. In the Active Policies panel, select the Insurance Management link on the Encounter or Patient Dashboard.

• Note: On the Encounter or Patient Dashboard, press [Ctrl + F7] on the keyboard to quickly navigate to Insurance Management.

2. Select the Add New Insurance Profile button.

3. Deselect the Default checkbox.
4. Select the Add New link.

5. Select the DME Insurance.
6. Enter the Policy number.
7. Select Save [F2].

8. Using Add New or From Existing link, add Secondary and Tertiary, if applicable. Skip this step if none exists.
9. Select Save [F2]. 

• Note: If this Save step is missed, the new Profile can be found in the Policies Not Part of an Insurance Profile panel.

DME Charge Example

1. From the Post or Modify Charge screens, choose the correct Insurance Profile from the Insurance dropdown.

• If the Insurance does not exist, select Manage in the Insurance dropdown to add a new Insurance Profile.

2. Select a Facility that is set up with POS 12 (typically required by Medicare and other Payers).

DME Claim Rejections

• Was the Claim sent to DMERC with the CFI MB?
• Does the claim have POS, 12 (home)?

• When POS 12 is used, the Patient's address is automatically populated on the Claim for the Place of Service.
• If you have not chosen 12 for the POS, modify the Encounter POS making sure each line item updates to POS 12.

• Is the Patient address the same as the real time Eligibility check?

• In the ERA Remit example below, the Patient address in the System is not the same as the one from the Medicare Eligibility response.

Resubmit the DME Claim

Resubmit the Claim with the address that Medicare has on file.

Example 1

• Temporarily change the address on the Demographics screen.
• Set the Claim to Ready for Submission/Resubmission.
• Submit the Claim.
• When it has been Clearinghouse accepted, change the address back to the original address.

Example 2

• If this is a person that lives at one address for several months and another address the rest of the time, you can create an additional Guarantor Statement address that is different from the address that is in the Demographics.
• Change the Demographic address to the Medicare address on the Eligibility Check.
• Add the Statement address to the Guarantor.