The “Bundled Value Code” field is a new field located on the electronic Medicare UB-04 Part A Institutional crossover claim form. When entering a claim in emomed, this field is located within the Header section of the online claim form. Providers may reference the Emomed Help button located on the upper right corner of the online claim form for definitions of the fields. The Help option defines the new “Bundled Value Code” field with the following: “Crossover bundled value codes are used if a group code of patient responsibility is entered on the other payer attachment with a reason code of 247 or 248. The valid codes are: Y5-Professional Deductible or Y3-Professional Coinsurance.”
The Claim Adjustment Reason Codes (CARC’s) 247 and 248 may be found on the Washington Publishing Company website, which is linked from the MO HealthNet Provider Participation page. The CARC 247 will appear on the Medicare Explanation of Benefits (EOB) when there is a deductible for professional service rendered in an institutional setting and the service was billed on an institutional claim. The CARC 248 will appear on the Medicare EOB, when there is a coinsurance for professional service rendered in an institutional setting and the service was billed on an institutional claim.
When billing a Medicare Part A crossover claim in which professional services were billed to Medicare, and there is a Patient Responsibility (PR) amount with reason code 247 or 248, select the appropriate bundled value code from the drop down box. When there is PR 247, choose the value code Y5; and for a PR 248, choose the value code Y3.
If the CARC’s 247 or 248 do not appear on the EOB, do not enter anything in the Bundled Value Code field. This is not a required field unless CARC’s 247 or 248 appear on the Medicare EOB.