Have you ever had a client contact you regarding a billing problem caused by incorrectly coded TPL on the MERI? We are all familiar with the monthly TPL code list that is distributed by e-mail from the TPL office. The code list contains good instructions on how to find the correct code for the client’s insurance company.
The document also includes instructions on how to delete an incorrect code properly, to fix the continuing problem that occurs when workers enter incorrect codes and do not delete them in the proper manner. Here are examples showing the two situations where you must correct the resource code on the MERI as soon as possible. Each situation has a different set of specific steps that must be followed just as they are written:
Example 1) You typed a wrong resource carrier code on the MERI today and you need to fix it immediately:
To CORRECT this problem:
- Make the end date the exact same as the start date and ENTER.
- Go back into the MERI and place a Y in the del field (to the far right of the MERI screen) and ENTER again.
- Go back into the MERI and notice that the erroneous segment is gone.
- Re-enter the information using the correct code.
- OR -
Example 2) You become aware of a wrong code on the MERI that has been there for weeks or months. It must be replaced with the correct code:
To CORRECT this problem:
- Make the end date exactly equal to the start date on the incorrect line.
- On the next TPR line, enter the correct information.
- Either send a note to the DMA mailbox to let them know you did this,
- Wait for at least one week and then go into the MERI, locate the segment to be deleted and place a Y in the del field (to the far right of the MERI screen) and ENTER.
**IMPORTANT NOTE: When deleting a MERI segment, the END date must be exactly equal to the start date. Otherwise, EIS will not allow you to delete the segment. It is also important to follow these directions exactly or the MMIS (Medicaid payment system) will retain erroneous information and cause billing and payment errors. PLEASE DO NOT DELETE MERI SEGMENTS unless you have a valid error. Please do not delete or terminate an insurance simply because a recipient asks you to. Ask them to mail you valid proof from the insurance company if the policy has terminated, or call the insurance company to verify a specific termination date.
Never delete insurance that has been entered by the TPL office without e-mailing them first to find out if the segment is still valid. The TPL office has many interface programs with insurance agencies and they enter insurance the eligibility technician may not have been aware of. Even when the client tells you that they don’t have that insurance, you must check with TPL office. Some clients are not aware they have insurance that may have been court ordered etc. This is very common with TRICARE.
Please continue to direct Inquiries to the DMA Mailbox: email@example.com
- Policy & Program Development