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How to submit claim for Laboratory service

September 10, 2011, 5:29 am
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Laboratory claim submission requirement


Many UnitedHealthcare benefit plan designs exclude from coverage outpatient diagnostic services that were not ordered by a participating physician. UnitedHealthcare benefit plans may also cover diagnostic services differently when a portion of the service (e.g., the draw) occurs in the physician’s office, but the analysis is performed by a laboratory provider. In addition, many state laws require that most, if not all, laboratory services are ordered by a licensed physician.

Therefore, all laboratory claims must include the NPI number of the referring physician, in addition to the other
elements of a Complete Claim described in this Guide. Laboratory claims that do not include the identity of the referring physician will be rejected or denied.

This requirement applies to claims for laboratory services, both anatomic and clinical.

This requirement applies to claims received from both participating and non-participating laboratories, unless
otherwise provided under applicable law. This requirement does not apply to claims for laboratory services provided by physicians in their offices. Please also refer to the Protocol on Use of Non-Participating Laboratory Services.
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Assistant surgeon and Erythropoietin claim submission tips

September 20, 2011, 5:31 am
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Assistant surgeons or surgical assistants claim submission requirements


The practice of directing or using non-participating providers significantly increases the costs of services for our members. As such, UnitedHealthcare requires our participating providers to use reasonable commercial efforts to utilize the services of in network providers, including in-network surgical assistants or assistant surgeons to render services to our members. Health care professionals acting as assistant surgeons must report their health care services under the primary surgeon’s TIN. Payment is subject to our payment policies (reimbursement policies).



Erythropoietin (For Commercial members)
For Erythropoietin (EPO) claims submitted via paper to UnitedHealthcare on a CMS-1500 Form, enter the Hematocrit  (Hct) level in the shaded area of line 24A in the same row as the J-code. Enter Hct and the lab value (Hctxx). For electronic claims, the Hct level is required in the (837P) Standard Professional Claim Transaction, Loop 2400 – Service Line, segment MEA, Data Element MEA03. The MEA segment should be reported as follows:

• MEA01 = qualifier “TR”, meaning test results
• MEA02 = qualifier “R2”, meaning hematocrit
• MEA03 = hematocrit test result
Example: MEA*TR*R2*33~
The following J codes require an Hct level on the claim:
• J0881 D arbepoetin alfa (non-ESRD use)
• J0882 D arbepoetin alfa (ESRD on dialysis)
• J0885 Epoetin alfa (non-ESRD use)
• J0886 Epoetin alfa, 1,000 units (for ESRD on Dialysis)
• Q4081 Epoetin alfa (ESRD on dialysis)
For EPO claims submitted on a UB04 claim form, an Hct level is not required.
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HCFA 1500 Problematic Fields for DOL claims

January 5, 2012, 4:10 am
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This is before HIPAA 5010

Box 1a or11 ––Claimant Case Number Claimant Case Number
Boxes 12 & 13 Boxes 12 & 13 ––““Signature on File Signature on File””
Box 21 Box 21 ––ICDICD-9 Diagnosis Codes 9 Diagnosis Codes
Box 24A Box 24A ––Dates of Service Dates of Service
Box 24D Box 24D ––CPT/HCPCS Procedure Codes CPT/HCPCS Procedure Codes and modifiers if applicable and modifiers if applicable
Box 24E ––Diagnosis pointers Diagnosis pointers
Box 24F ––Line Charges Line Charges
Box 24G ––Units
Box 25 ––Provider’’s Federal Tax ID #s Federal Tax ID #
Box 28 ––Total Charge
Box 31 ––Signature of physician and bill Signature of physician and bill date



BOX 31 –Treating Provider
Appropriate signatureAppropriate signature
Bill date must be after last date of service Bill date must be after last date of service

BOX 32 –Service Address
Address where service was rendered Address where service was rendered
To include Zip CodeTo include Zip Code


BOX 33 –Billing Address
Address where payment is sent Address where payment is sent
Provider number attained after enrollment Provider number attained after enrollment 
From a provider perspective this is the most important field on a HCFA. This information is vital to pay the correct provider.
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BCBS florida announcement on HIPAA 5010

January 6, 2012, 12:31 am
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The HIPAA 5010 compliance date has arrived! Are you ready?

Although January 1, 2012 is the official compliance date for submitting claims through the HIPAA 5010 electronic data interchange (EDI) standards, the Centers for Medicare & Medicaid Services' (CMS) Office of E-Health Standards and Services (OESS) will not initiate enforcement action until April 1, 2012.  Nonetheless, it is important to recognize that the 5010 compliance date is upon us and has not changed.

Blue Cross and Blue Shield of Florida, Inc. (BCBSF) is now accepting transactions using the mandated 5010 standards. We are also accommodating the CMS 5010 enforcement grace period and will not reject 4010/4010A transactions until April 1, 2012.

If you are not yet HIPAA 5010 compliant, BCBSF urges you to keep moving forward toward achieving compliance.  Reach out to your vendors and payers to confirm compliance. As you probably now know, conformity to 5010 standards is a crucial prerequisite step toward the greater ICD-10 code set mandate which is rapidly approaching.  The ICD-10 compliance date is October 1, 2013.

Be sure to attend our HIPAA 5010 Open Line Friday teleconferences which will continue to take place weekly until further notice.  For direct access to valuable 5010-related information and resources, visit our website (www.bcbsfl.com) or simply click on the 5010 icon below.
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UB-92 Problematic Fields for DOL claims

January 10, 2012, 6:22 am
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Box 1 ––Billing Address Billing Address
Box 4 ––Type of billT ype of bill
Box 5 ––Provider tax ID number Provider tax ID number
Box 6 ––Statement covers period Statement covers period
Box 17 to 20 ––Admission Admission (date/hour/type/source)(date/hour/type/source)
Box 21 & 22 Box 21 & 22 ––Discharge hour and Discharge hour and Discharge status Discharge status
Box 42 to 47 ––Detail line items (Provide Detail line items (Provide HCPCS for required HCPCS for required RCCRCC’’s)
Box 51 ––Provider number and Medicare Provider number and Medicare
number number
Box 60 ––Claimant Claimant’’s case numbers case number
Box 67 to 75 ––ICD-9 Diagnosis codes 9 Diagnosis codes
Box 80 to 81 ––Appropriate procedure codes Appropriate procedure codes

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Important fields of the CMS 1500 Form during the claim submission

July 23, 2013, 10:40 pm
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Claims submitted for payment should be in a HIPAA accepted 837 file format and filed electronically using the CarePlus Payer ID 95092 to Availity at www.availity.com. If all EDI methods have failed and the provider has contacted the CarePlus Claims Status team for assistance, the provider may then submit  their claim on a properly completed CMS 1500 form within the time frame specified in their contract.

**  Patient name
**  Patient ID number
**  Group number
**  Patient DOB
**  Patient address and telephone number
**  Other insurance information
-  Insured name
-  Insurance name
-  Policy/ Group number
**  Attach other insurance EOBs to show payment or denial
**  If patient’s condition is related to:
-  Employment (Worker’s Compensation)
-  Auto Accident
-  Other Accident
**  Referring Physician (when applicable)
**  Referring Physicians NPI #
**  Authorization number
**  ICD-9 Diagnosis Code(s)
**  Date(s) of Service
**  Place of Service & Type of Service
**  CPT-4 HCPC Procedure Codes and (modifiers when applicable)
**  Charges
**  Days or Units
**  CHCU-Family Planning
**  EMG
**  COB
**  Federal TID number
**  Patients account number
**  Accept assignment- Y or N
**  Total charges
**  Amount paid
**  Balance due
**  Name of Physician or supplier of service
**  NPI # of Physicians or supplier of service
**  Billing Providers NPI #
**  Name and address of facility where services were rendered (if other than home or office)
**  Physician name and address according to the contract
**  Plan assigned provider number
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New CMS 1500 form update BOX 17

January 13, 2014, 1:22 am
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Item 17 - Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician . All physicians who order services or refer Medicare beneficiaries must report this data. Similarly, if Medicare policy requires you to report a supervising physician, enter this information in item
17. When a claim involves multiple referring, ordering, or supervising physicians, use a separate CMS-1500 claim form for each ordering, referring, or supervising physician.

Additional instructions for form version 02/12: Enter one of the following qualifiers as appropriate to identify the role that this physician (or non-physician ractitioner) is performing:


Qualifier Provider Role 

DN Referring Provider
DK Ordering Provider
DQ Supervising Provider

Enter the qualifier to the left of the dotted vertical line on item 17.


NOTE: Under certain circumstances, Medicare permits a non-physician practitioner to perform these roles. Refer to Pub 100-02, Medicare Benefit Policy Manual, chapter 15 for non-physician practitioner rules. Enter non-physician practitioner information according to the rules above for physicians.

The term "physician" when used within the meaning of §1861(r) of the Act and used in connection with performing any function or action refers to:

1. A doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he/she performs such function or action;

2. A doctor of dental surgery or dental medicine who is legally authorized to practice dentistry by the State in which he/she performs such functions and who is acting within the scope of his/her license when performing such functions;

3. A doctor of podiatric medicine for purposes of §§(k), (m), (p)(1), and (s) and §§1814(a), 1832(a)(2)(F)(ii), and 1835 of the Act, but only with respect to functions which he/she is legally authorized to perform as such by the State in which he/she performs them;

4. A doctor of optometry, but only with respect to the provision of items or services described in §1861(s) of the Act which he/she is legally authorized to perform as a doctor of optometry by the State in which he/she performs them; or

5. A chiropractor who is licensed as such by a State (or in a State which does not license chiropractors as such), and is legally authorized to perform the services of a chiropractor in the jurisdiction in which he/she performs such services, and who meets uniform minimum standards specified by the Secretary, but only for purposes of §§1861(s)(1) and 1861(s)(2)(A) of the Act, and only with respect to treatment by means of manual manipulation of the spine (to correct a subluxation). For the purposes of §1862(a)(4) of the Act and subject to the limitations and conditions provided above, chiropractor includes a doctor of one of the arts specified in the statute and legally authorized to practice such art in the country in which the inpatient hospital services (referred to in §1862(a)(4) of the Act) are furnished.

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EDI claim status code - Full list

January 20, 2014, 1:15 am
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Here is the full list of EDI claim status code. It may be a denial, rejection and Acknowledgement.


0
Cannot provide further status electronically.
Start: 01/01/1995
1For more detailed information, see remittance advice.
Start: 01/01/1995
2More detailed information in letter.
Start: 01/01/1995
3Claim has been adjudicated and is awaiting payment cycle.
Start: 01/01/1995
6Balance due from the subscriber.
Start: 01/01/1995
12One or more originally submitted procedure codes have been combined.
Start: 01/01/1995 | Last Modified: 06/30/2001
15One or more originally submitted procedure code have been modified.
Start: 01/01/1995 | Last Modified: 06/30/2001
16Claim/encounter has been forwarded to entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
17Claim/encounter has been forwarded by third party entity to entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
18Entity received claim/encounter, but returned invalid status. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
19Entity acknowledges receipt of claim/encounter. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
20Accepted for processing.
Start: 01/01/1995 | Last Modified: 06/30/2001
21Missing or invalid information. Note: At least one other status code is required to identify the missing or invalid information.
Start: 01/01/1995 | Last Modified: 07/09/2007
23Returned to Entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
24Entity not approved as an electronic submitter. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
25Entity not approved. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
26Entity not found. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
27Policy canceled.
Start: 01/01/1995 | Last Modified: 06/30/2001
29Subscriber and policy number/contract number mismatched.
Start: 01/01/1995
30Subscriber and subscriber id mismatched.
Start: 01/01/1995
31Subscriber and policyholder name mismatched.
Start: 01/01/1995
32Subscriber and policy number/contract number not found.
Start: 01/01/1995
33Subscriber and subscriber id not found.
Start: 01/01/1995
34Subscriber and policyholder name not found.
Start: 01/01/1995
35Claim/encounter not found.
Start: 01/01/1995
37Predetermination is on file, awaiting completion of services.
Start: 01/01/1995
38Awaiting next periodic adjudication cycle.
Start: 01/01/1995
39Charges for pregnancy deferred until delivery.
Start: 01/01/1995
40Waiting for final approval.
Start: 01/01/1995
41Special handling required at payer site.
Start: 01/01/1995
42Awaiting related charges.
Start: 01/01/1995
44Charges pending provider audit.
Start: 01/01/1995
45Awaiting benefit determination.
Start: 01/01/1995
46Internal review/audit.
Start: 01/01/1995
47Internal review/audit - partial payment made.
Start: 01/01/1995
49Pending provider accreditation review.
Start: 01/01/1995
50Claim waiting for internal provider verification.
Start: 01/01/1995
51Investigating occupational illness/accident.
Start: 01/01/1995
52Investigating existence of other insurance coverage.
Start: 01/01/1995
53Claim being researched for Insured ID/Group Policy Number error.
Start: 01/01/1995
54Duplicate of a previously processed claim/line.
Start: 01/01/1995
55Claim assigned to an approver/analyst.
Start: 01/01/1995
56Awaiting eligibility determination.
Start: 01/01/1995
57Pending COBRA information requested.
Start: 01/01/1995
59Information was requested by a non-electronic method. Note: At least one other status code is required to identify the requested information.
Start: 01/01/1995 | Last Modified: 10/17/2010
60Information was requested by an electronic method. Note: At least one other status code is required to identify the requested information.
Start: 01/01/1995 | Last Modified: 10/17/2010
61Eligibility for extended benefits.
Start: 01/01/1995
64Re-pricing information.
Start: 01/01/1995
65Claim/line has been paid.
Start: 01/01/1995
66Payment reflects usual and customary charges.
Start: 01/01/1995
72Claim contains split payment.
Start: 01/01/1995
73Payment made to entity, assignment of benefits not on file. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
78Duplicate of an existing claim/line, awaiting processing.
Start: 01/01/1995
81Contract/plan does not cover pre-existing conditions.
Start: 01/01/1995
83No coverage for newborns.
Start: 01/01/1995
84Service not authorized.
Start: 01/01/1995
85Entity not primary. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
86Diagnosis and patient gender mismatch.
Start: 01/01/1995 | Last Modified: 02/28/2000
88Entity not eligible for benefits for submitted dates of service. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
89Entity not eligible for dental benefits for submitted dates of service. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
90Entity not eligible for medical benefits for submitted dates of service. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
91Entity not eligible/not approved for dates of service. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
92Entity does not meet dependent or student qualification. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
93Entity is not selected primary care provider. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
94Entity not referred by selected primary care provider. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
95Requested additional information not received.
Start: 01/01/1995 | Last Modified: 07/09/2007
Notes: If known, the payer must report a second claim status code identifying the requested information.
96No agreement with entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
97Patient eligibility not found with entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
98Charges applied to deductible.
Start: 01/01/1995
99Pre-treatment review.
Start: 01/01/1995
100Pre-certification penalty taken.
Start: 01/01/1995
101Claim was processed as adjustment to previous claim.
Start: 01/01/1995
102Newborn's charges processed on mother's claim.
Start: 01/01/1995
103Claim combined with other claim(s).
Start: 01/01/1995
104Processed according to plan provisions (Plan refers to provisions that exist between the Health Plan and the Consumer or Patient)
Start: 01/01/1995 | Last Modified: 06/01/2008
105Claim/line is capitated.
Start: 01/01/1995
106This amount is not entity's responsibility. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
107Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)
Start: 01/01/1995 | Last Modified: 06/01/2008
109Entity not eligible. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
110Claim requires pricing information.
Start: 01/01/1995
111At the policyholder's request these claims cannot be submitted electronically.
Start: 01/01/1995
114Claim/service should be processed by entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
116Claim submitted to incorrect payer.
Start: 01/01/1995
117Claim requires signature-on-file indicator.
Start: 01/01/1995
121Service line number greater than maximum allowable for payer.
Start: 01/01/1995
123Additional information requested from entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
124Entity's name, address, phone and id number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
125Entity's name. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
126Entity's address. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
127Entity's Communication Number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 06/06/2010
128Entity's tax id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
129Entity's Blue Cross provider id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
130Entity's Blue Shield provider id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
131Entity's Medicare provider id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
132Entity's Medicaid provider id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
133Entity's UPIN. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
134Entity's CHAMPUS provider id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
135Entity's commercial provider id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
136Entity's health industry id number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
137Entity's plan network id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
138Entity's site id . Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
139Entity's health maintenance provider id (HMO). Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
140Entity's preferred provider organization id (PPO). Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
141Entity's administrative services organization id (ASO). Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
142Entity's license/certification number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
143Entity's state license number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
144Entity's specialty license number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
145Entity's specialty/taxonomy code. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
146Entity's anesthesia license number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
147Entity's qualification degree/designation (e.g. RN,PhD,MD). Note: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 02/11/2010
148Entity's social security number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
149Entity's employer id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
150Entity's drug enforcement agency (DEA) number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
152Pharmacy processor number.
Start: 01/01/1995
153Entity's id number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
154Relationship of surgeon & assistant surgeon.
Start: 01/01/1995
155Entity's relationship to patient. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
156Patient relationship to subscriber
Start: 01/01/1995
157Entity's Gender. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
158Entity's date of birth. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
159Entity's date of death. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
160Entity's marital status. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
161Entity's employment status. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
162Entity's health insurance claim number (HICN). Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
163Entity's policy number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
164Entity's contract/member number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
165Entity's employer name, address and phone. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
166Entity's employer name. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
167Entity's employer address. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
168Entity's employer phone number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
170Entity's employee id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
171Other insurance coverage information (health, liability, auto, etc.).
Start: 01/01/1995
172Other employer name, address and telephone number.
Start: 01/01/1995
173Entity's name, address, phone, gender, DOB, marital status, employment status and relation to subscriber. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
174Entity's student status. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
175Entity's school name. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
176Entity's school address. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
177Transplant recipient's name, date of birth, gender, relationship to insured.
Start: 01/01/1995 | Last Modified: 02/28/2000
178Submitted charges.
Start: 01/01/1995
179Outside lab charges.
Start: 01/01/1995
180Hospital s semi-private room rate.
Start: 01/01/1995
181Hospital s room rate.
Start: 01/01/1995
182Allowable/paid from other entities coverage NOTE: This code requires the use of an entity code.
Start: 01/01/1995 | Last Modified: 01/24/2010
183Amount entity has paid. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
184Purchase price for the rented durable medical equipment.
Start: 01/01/1995
185Rental price for durable medical equipment.
Start: 01/01/1995
186Purchase and rental price of durable medical equipment.
Start: 01/01/1995
187Date(s) of service.
Start: 01/01/1995
188Statement from-through dates.
Start: 01/01/1995
189Facility admission date
Start: 01/01/1995 | Last Modified: 10/31/2006
190Facility discharge date
Start: 01/01/1995 | Last Modified: 10/31/2006
191Date of Last Menstrual Period (LMP)
Start: 02/28/1997
192Date of first service for current series/symptom/illness.
Start: 01/01/1995
193First consultation/evaluation date.
Start: 02/28/1997
194Confinement dates.
Start: 01/01/1995
195Unable to work dates/Disability Dates.
Start: 01/01/1995 | Last Modified: 09/20/2009
196Return to work dates.
Start: 01/01/1995
197Effective coverage date(s).
Start: 01/01/1995
198Medicare effective date.
Start: 01/01/1995
199Date of conception and expected date of delivery.
Start: 01/01/1995
200Date of equipment return.
Start: 01/01/1995
201Date of dental appliance prior placement.
Start: 01/01/1995
202Date of dental prior replacement/reason for replacement.
Start: 01/01/1995
203Date of dental appliance placed.
Start: 01/01/1995
204Date dental canal(s) opened and date service completed.
Start: 01/01/1995
205Date(s) dental root canal therapy previously performed.
Start: 01/01/1995
206Most recent date of curettage, root planing, or periodontal surgery.
Start: 01/01/1995
207Dental impression and seating date.
Start: 01/01/1995
208Most recent date pacemaker was implanted.
Start: 01/01/1995
209Most recent pacemaker battery change date.
Start: 01/01/1995
210Date of the last x-ray.
Start: 01/01/1995
211Date(s) of dialysis training provided to patient.
Start: 01/01/1995
212Date of last routine dialysis.
Start: 01/01/1995
213Date of first routine dialysis.
Start: 01/01/1995
214Original date of prescription/orders/referral.
Start: 02/28/1997
215Date of tooth extraction/evolution.
Start: 01/01/1995
216Drug information.
Start: 01/01/1995
217Drug name, strength and dosage form.
Start: 01/01/1995
218NDC number.
Start: 01/01/1995
219Prescription number.
Start: 01/01/1995
222Drug dispensing units and average wholesale price (AWP).
Start: 01/01/1995
223Route of drug/myelogram administration.
Start: 01/01/1995
224Anatomical location for joint injection.
Start: 01/01/1995
225Anatomical location.
Start: 01/01/1995
226Joint injection site.
Start: 01/01/1995
227Hospital information.
Start: 01/01/1995
228Type of bill for UB claim
Start: 01/01/1995 | Last Modified: 10/31/2006
229Hospital admission source.
Start: 01/01/1995
230Hospital admission hour.
Start: 01/01/1995
231Hospital admission type.
Start: 01/01/1995
232Admitting diagnosis.
Start: 01/01/1995
233Hospital discharge hour.
Start: 01/01/1995
234Patient discharge status.
Start: 01/01/1995
235Units of blood furnished.
Start: 01/01/1995
236Units of blood replaced.
Start: 01/01/1995
237Units of deductible blood.
Start: 01/01/1995
238Separate claim for mother/baby charges.
Start: 01/01/1995
239Dental information.
Start: 01/01/1995
240Tooth surface(s) involved.
Start: 01/01/1995
241List of all missing teeth (upper and lower).
Start: 01/01/1995
242Tooth numbers, surfaces, and/or quadrants involved.
Start: 01/01/1995
243Months of dental treatment remaining.
Start: 01/01/1995
244Tooth number or letter.
Start: 01/01/1995
245Dental quadrant/arch.
Start: 01/01/1995
246Total orthodontic service fee, initial appliance fee, monthly fee, length of service.
Start: 01/01/1995
247Line information.
Start: 01/01/1995
249Place of service.
Start: 01/01/1995
250Type of service.
Start: 01/01/1995
251Total anesthesia minutes.
Start: 01/01/1995
252Entity's authorization/certification number. Note: This code requires the use of an Entity Code.
Start: 01/01/1995 | Last Modified: 01/30/2011
254Principal diagnosis code.
Start: 01/01/1995 | Last Modified: 01/30/2011
255Diagnosis code.
Start: 01/01/1995
256DRG code(s).
Start: 01/01/1995
257ADSM-III-R code for services rendered.
Start: 01/01/1995
258Days/units for procedure/revenue code.
Start: 01/01/1995
259Frequency of service.
Start: 01/01/1995
260Length of medical necessity, including begin date.
Start: 02/28/1997
261Obesity measurements.
Start: 01/01/1995
262Type of surgery/service for which anesthesia was administered.
Start: 01/01/1995
263Length of time for services rendered.
Start: 01/01/1995
264Number of liters/minute & total hours/day for respiratory support.
Start: 01/01/1995
265Number of lesions excised.
Start: 01/01/1995
266Facility point of origin and destination - ambulance.
Start: 01/01/1995
267Number of miles patient was transported.
Start: 01/01/1995
268Location of durable medical equipment use.
Start: 01/01/1995
269Length/size of laceration/tumor.
Start: 01/01/1995
270Subluxation location.
Start: 01/01/1995
271Number of spine segments.
Start: 01/01/1995
272Oxygen contents for oxygen system rental.
Start: 01/01/1995
273Weight.
Start: 01/01/1995
274Height.
Start: 01/01/1995
275Claim.
Start: 01/01/1995
276UB04/HCFA-1450/1500 claim form
Start: 01/01/1995 | Last Modified: 10/31/2006
277Paper claim.
Start: 01/01/1995
279Claim/service must be itemized
Start: 01/01/1995 | Last Modified: 10/17/2010
281Related confinement claim.
Start: 01/01/1995
282Copy of prescription.
Start: 01/01/1995
283Medicare entitlement information is required to determine primary coverage
Start: 01/01/1995 | Last Modified: 01/27/2008
284Copy of Medicare ID card.
Start: 01/01/1995
286Other payer's Explanation of Benefits/payment information.
Start: 01/01/1995
287Medical necessity for service.
Start: 01/01/1995
288Hospital late charges
Start: 01/01/1995 | Last Modified: 10/17/2010
290Pre-existing information.
Start: 01/01/1995
291Reason for termination of pregnancy.
Start: 01/01/1995
292Purpose of family conference/therapy.
Start: 01/01/1995
293Reason for physical therapy.
Start: 01/01/1995
294Supporting documentation. Note: At least one other status code is required to identify the supporting documentation.
Start: 01/01/1995 | Last Modified: 10/17/2010
295Attending physician report.
Start: 01/01/1995
296Nurse's notes.
Start: 01/01/1995
297Medical notes/report.
Start: 02/28/1997
298Operative report.
Start: 01/01/1995
299Emergency room notes/report.
Start: 01/01/1995
300Lab/test report/notes/results.
Start: 02/28/1997
301MRI report.
Start: 01/01/1995
305Radiology/x-ray reports and/or interpretation
Start: 01/01/1995 | Last Modified: 01/30/2011
306Detailed description of service.
Start: 01/01/1995
307Narrative with pocket depth chart.
Start: 01/01/1995
308Discharge summary.
Start: 01/01/1995
310Progress notes for the six months prior to statement date.
Start: 01/01/1995
311Pathology notes/report.
Start: 01/01/1995
312Dental charting.
Start: 01/01/1995
313Bridgework information.
Start: 01/01/1995
314Dental records for this service.
Start: 01/01/1995
315Past perio treatment history.
Start: 01/01/1995
316Complete medical history.
Start: 01/01/1995
318X-rays/radiology films
Start: 01/01/1995 | Last Modified: 10/17/2010
319Pre/post-operative x-rays/photographs.
Start: 02/28/1997
320Study models.
Start: 01/01/1995
322Recent Full Mouth X-rays
Start: 01/01/1995 | Last Modified: 10/17/2010
323Study models, x-rays, and/or narrative.
Start: 01/01/1995
324Recent x-ray of treatment area and/or narrative.
Start: 01/01/1995
325Recent fm x-rays and/or narrative.
Start: 01/01/1995
326Copy of transplant acquisition invoice.
Start: 01/01/1995
327Periodontal case type diagnosis and recent pocket depth chart with narrative.
Start: 01/01/1995
329Exercise notes.
Start: 01/01/1995
330Occupational notes.
Start: 01/01/1995
331History and physical.
Start: 01/01/1995 | Last Modified: 08/01/2007
333Patient release of information authorization.
Start: 01/01/1995
334Oxygen certification.
Start: 01/01/1995
335Durable medical equipment certification.
Start: 01/01/1995
336Chiropractic certification.
Start: 01/01/1995
337Ambulance certification/documentation.
Start: 01/01/1995
339Enteral/parenteral certification.
Start: 01/01/1995
340Pacemaker certification.
Start: 01/01/1995
341Private duty nursing certification.
Start: 01/01/1995
342Podiatric certification.
Start: 01/01/1995
343Documentation that facility is state licensed and Medicare approved as a surgical facility.
Start: 01/01/1995
344Documentation that provider of physical therapy is Medicare Part B approved.
Start: 01/01/1995
345Treatment plan for service/diagnosis
Start: 01/01/1995
346Proposed treatment plan for next 6 months.
Start: 01/01/1995
352Duration of treatment plan.
Start: 01/01/1995
353Orthodontics treatment plan.
Start: 01/01/1995
354Treatment plan for replacement of remaining missing teeth.
Start: 01/01/1995
360Benefits Assignment Certification Indicator
Start: 01/01/1995 | Last Modified: 10/17/2010
363Possible Workers' Compensation
Start: 01/01/1995 | Last Modified: 10/17/2010
364Is accident/illness/condition employment related?
Start: 01/01/1995
365Is service the result of an accident?
Start: 01/01/1995
366Is injury due to auto accident?
Start: 01/01/1995
374Is prescribed lenses a result of cataract surgery?
Start: 01/01/1995
375Was refraction performed?
Start: 01/01/1995
380CRNA supervision/medical direction.
Start: 01/01/1995 | Last Modified: 10/17/2010
382Did provider authorize generic or brand name dispensing?
Start: 01/01/1995
383Nerve block use (surgery vs. pain management)
Start: 01/01/1995 | Last Modified: 10/17/2010
384Is prosthesis/crown/inlay placement an initial placement or a replacement?
Start: 01/01/1995
385Is appliance upper or lower arch & is appliance fixed or removable?
Start: 01/01/1995
386Orthodontic Treatment/Purpose Indicator
Start: 01/01/1995 | Last Modified: 10/17/2010
387Date patient last examined by entity. Note: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 02/11/2010
388Date post-operative care assumed
Start: 02/28/1997
389Date post-operative care relinquished
Start: 02/28/1997
390Date of most recent medical event necessitating service(s)
Start: 02/28/1997
391Date(s) dialysis conducted
Start: 02/28/1997
394Date(s) of most recent hospitalization related to service
Start: 02/28/1997
395Date entity signed certification/recertification Note: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 02/11/2010
396Date home dialysis began
Start: 02/28/1997
397Date of onset/exacerbation of illness/condition
Start: 02/28/1997
398Visual field test results
Start: 02/28/1997
400Claim is out of balance
Start: 02/28/1997
401Source of payment is not valid
Start: 02/28/1997
402Amount must be greater than zero. Note: At least one other status code is required to identify which amount element is in error.
Start: 02/28/1997 | Last Modified: 09/20/2009
403Entity referral notes/orders/prescription
Start: 02/28/1997
406Brief medical history as related to service(s)
Start: 02/28/1997
407Complications/mitigating circumstances
Start: 02/28/1997
408Initial certification
Start: 02/28/1997
409Medication logs/records (including medication therapy)
Start: 02/28/1997
414Necessity for concurrent care (more than one physician treating the patient)
Start: 02/28/1997 | Last Modified: 10/17/2010
417Prior testing, including result(s) and date(s) as related to service(s)
Start: 02/28/1997
419Individual test(s) comprising the panel and the charges for each test
Start: 02/28/1997
420Name, dosage and medical justification of contrast material used for radiology procedure
Start: 02/28/1997
428Reason for transport by ambulance
Start: 02/28/1997
430Nearest appropriate facility
Start: 02/28/1997
431Patient's condition/functional status at time of service.
Start: 02/28/1997 | Last Modified: 10/17/2010
432Date benefits exhausted
Start: 02/28/1997
433Copy of patient revocation of hospice benefits
Start: 02/28/1997
434Reasons for more than one transfer per entitlement period
Start: 02/28/1997
435Notice of Admission
Start: 02/28/1997
441Entity professional qualification for service(s)
Start: 02/28/1997
442Modalities of service
Start: 02/28/1997
443Initial evaluation report
Start: 02/28/1997
449Projected date to discontinue service(s)
Start: 02/28/1997
450Awaiting spend down determination
Start: 02/28/1997
451Preoperative and post-operative diagnosis
Start: 02/28/1997
452Total visits in total number of hours/day and total number of hours/week
Start: 02/28/1997
453Procedure Code Modifier(s) for Service(s) Rendered
Start: 02/28/1997
454Procedure code for services rendered.
Start: 02/28/1997
455Revenue code for services rendered.
Start: 02/28/1997
456Covered Day(s)
Start: 02/28/1997
457Non-Covered Day(s)
Start: 02/28/1997
458Coinsurance Day(s)
Start: 02/28/1997
459Lifetime Reserve Day(s)
Start: 02/28/1997
460NUBC Condition Code(s)
Start: 02/28/1997
464Payer Assigned Claim Control Number
Start: 02/28/1997 | Last Modified: 10/31/2004
465Principal Procedure Code for Service(s) Rendered
Start: 02/28/1997
466Entity's Original Signature. Note: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 01/30/2011
467Entity Signature Date. Note: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 02/11/2010
468Patient Signature Source
Start: 02/28/1997
469Purchase Service Charge
Start: 02/28/1997
470Was service purchased from another entity? Note: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 02/11/2010
471Were services related to an emergency?
Start: 02/28/1997
472Ambulance Run Sheet
Start: 02/28/1997
473Missing or invalid lab indicator
Start: 06/30/1998
474Procedure code and patient gender mismatch
Start: 06/30/1998 | Last Modified: 02/29/2000
475Procedure code not valid for patient age
Start: 06/30/1998 | Last Modified: 02/29/2000
476Missing or invalid units of service
Start: 06/30/1998
477Diagnosis code pointer is missing or invalid
Start: 06/30/1998
478Claim submitter's identifier
Start: 06/30/1998 | Last Modified: 01/24/2010
479Other Carrier payer ID is missing or invalid
Start: 06/30/1998
480Entity's claim filing indicator. Note: This code requires use of an Entity Code.
Start: 06/30/1998 | Last Modified: 06/06/2010
481Claim/submission format is invalid.
Start: 10/31/1998
483Maximum coverage amount met or exceeded for benefit period.
Start: 06/30/1999
484Business Application Currently Not Available
Start: 02/29/2000
485More information available than can be returned in real time mode. Narrow your current search criteria.
Start: 02/28/2001
486Principal Procedure Date
Start: 10/31/2001 | Last Modified: 07/01/2009
487Claim not found, claim should have been submitted to/through 'entity'. Note: This code requires use of an Entity Code.
Start: 02/28/2002 | Last Modified: 02/11/2010
488Diagnosis code(s) for the services rendered.
Start: 06/30/2002
489Attachment Control Number
Start: 10/31/2002
490Other Procedure Code for Service(s) Rendered
Start: 02/28/2003
491Entity not eligible for encounter submission. Note: This code requires use of an Entity Code.
Start: 02/28/2003 | Last Modified: 02/11/2010
492Other Procedure Date
Start: 02/28/2003
493Version/Release/Industry ID code not currently supported by information holder
Start: 02/28/2003
494Real-Time requests not supported by the information holder, resubmit as batch request
Start: 02/28/2003
495Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim. Correct the payer claim control number and re-submit.
Start: 10/31/2003
496Submitter not approved for electronic claim submissions on behalf of this entity. Note: This code requires use of an Entity Code.
Start: 02/29/2004 | Last Modified: 02/11/2010
497Sales tax not paid
Start: 06/30/2004
498Maximum leave days exhausted
Start: 06/30/2004
499No rate on file with the payer for this service for this entity Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
500Entity's Postal/Zip Code. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
501Entity's State/Province. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
502Entity's City. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
503Entity's Street Address. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
504Entity's Last Name. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
505Entity's First Name. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
506Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
507HCPCS
Start: 10/31/2004
508ICD9 NOTE: At least one other status code is required to identify the related procedure code or diagnosis code.
Start: 10/31/2004 | Last Modified: 07/01/2009
509External Cause of Injury Code (E-code).
Start: 10/31/2004 | Last Modified: 01/30/2011
510Future date. Note: At least one other status code is required to identify the data element in error.
Start: 10/31/2004 | Last Modified: 09/20/2009
511Invalid character. Note: At least one other status code is required to identify the data element in error.
Start: 10/31/2004 | Last Modified: 09/20/2009
512Length invalid for receiver's application system. Note: At least one other status code is required to identify the data element in error.
Start: 10/31/2004 | Last Modified: 09/20/2009
513HIPPS Rate Code for services Rendered
Start: 10/31/2004
514Entity's Middle Name Note: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 01/30/2011
515Managed Care review
Start: 10/31/2004
516Other Entity's Adjudication or Payment/Remittance Date. Note: An Entity code is required to identify the Other Payer Entity, i.e. primary, secondary.
Start: 10/31/2004 | Last Modified: 11/29/2009
517Adjusted Repriced Claim Reference Number
Start: 10/31/2004
518Adjusted Repriced Line item Reference Number
Start: 10/31/2004
519Adjustment Amount
Start: 10/31/2004
520Adjustment Quantity
Start: 10/31/2004
521Adjustment Reason Code
Start: 10/31/2004
522Anesthesia Modifying Units
Start: 10/31/2004
523Anesthesia Unit Count
Start: 10/31/2004
524Arterial Blood Gas Quantity
Start: 10/31/2004
525Begin Therapy Date
Start: 10/31/2004
526Bundled or Unbundled Line Number
Start: 10/31/2004
527Certification Condition Indicator
Start: 10/31/2004
528Certification Period Projected Visit Count
Start: 10/31/2004
529Certification Revision Date
Start: 10/31/2004
530Claim Adjustment Indicator
Start: 10/31/2004
531Claim Disproportinate Share Amount
Start: 10/31/2004
532Claim DRG Amount
Start: 10/31/2004
533Claim DRG Outlier Amount
Start: 10/31/2004
534Claim ESRD Payment Amount
Start: 10/31/2004
535Claim Frequency Code
Start: 10/31/2004
536Claim Indirect Teaching Amount
Start: 10/31/2004
537Claim MSP Pass-through Amount
Start: 10/31/2004
538Claim or Encounter Identifier
Start: 10/31/2004
539Claim PPS Capital Amount
Start: 10/31/2004
540Claim PPS Capital Outlier Amount
Start: 10/31/2004
541Claim Submission Reason Code
Start: 10/31/2004
542Claim Total Denied Charge Amount
Start: 10/31/2004
543Clearinghouse or Value Added Network Trace
Start: 10/31/2004
544Clinical Laboratory Improvement Amendment
Start: 10/31/2004
545Contract Amount
Start: 10/31/2004
546Contract Code
Start: 10/31/2004
547Contract Percentage
Start: 10/31/2004
548Contract Type Code
Start: 10/31/2004
549Contract Version Identifier
Start: 10/31/2004
550Coordination of Benefits Code
Start: 10/31/2004
551Coordination of Benefits Total Submitted Charge
Start: 10/31/2004
552Cost Report Day Count
Start: 10/31/2004
553Covered Amount
Start: 10/31/2004
554Date Claim Paid
Start: 10/31/2004
555Delay Reason Code
Start: 10/31/2004
556Demonstration Project Identifier
Start: 10/31/2004
557Diagnosis Date
Start: 10/31/2004
558Discount Amount
Start: 10/31/2004
559Document Control Identifier
Start: 10/31/2004
560Entity's Additional/Secondary Identifier. Note: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 02/11/2010
561Entity's Contact Name. Note: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 02/11/2010
562Entity's National Provider Identifier (NPI). Note: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 02/11/2010
563Entity's Tax Amount. Note: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 02/11/2010
564EPSDT Indicator
Start: 10/31/2004
565Estimated Claim Due Amount
Start: 10/31/2004
566Exception Code
Start: 10/31/2004
567Facility Code Qualifier
Start: 10/31/2004
568Family Planning Indicator
Start: 10/31/2004
569Fixed Format Information
Start: 10/31/2004
571Frequency Count
Start: 10/31/2004
572Frequency Period
Start: 10/31/2004
573Functional Limitation Code
Start: 10/31/2004
574HCPCS Payable Amount Home Health
Start: 10/31/2004
575Homebound Indicator
Start: 10/31/2004
576Immunization Batch Number
Start: 10/31/2004
577Industry Code
Start: 10/31/2004
578Insurance Type Code
Start: 10/31/2004
579Investigational Device Exemption Identifier
Start: 10/31/2004
580Last Certification Date
Start: 10/31/2004
581Last Worked Date
Start: 10/31/2004
582Lifetime Psychiatric Days Count
Start: 10/31/2004
583Line Item Charge Amount
Start: 10/31/2004
584Line Item Control Number
Start: 10/31/2004
585Denied Charge or Non-covered Charge
Start: 10/31/2004 | Last Modified: 07/09/2007
586Line Note Text
Start: 10/31/2004
587Measurement Reference Identification Code
Start: 10/31/2004
588Medical Record Number
Start: 10/31/2004
589Provider Accept Assignment Code
Start: 10/31/2004 | Last Modified: 10/17/2010
590Medicare Coverage Indicator
Start: 10/31/2004
591Medicare Paid at 100% Amount
Start: 10/31/2004
592Medicare Paid at 80% Amount
Start: 10/31/2004
593Medicare Section 4081 Indicator
Start: 10/31/2004
594Mental Status Code
Start: 10/31/2004
595Monthly Treatment Count
Start: 10/31/2004
596Non-covered Charge Amount
Start: 10/31/2004
597Non-payable Professional Component Amount
Start: 10/31/2004
598Non-payable Professional Component Billed Amount
Start: 10/31/2004
599Note Reference Code
Start: 10/31/2004
600Oxygen Saturation Qty
Start: 10/31/2004
601Oxygen Test Condition Code
Start: 10/31/2004
602Oxygen Test Date
Start: 10/31/2004
603Old Capital Amount
Start: 10/31/2004
604Originator Application Transaction Identifier
Start: 10/31/2004
605Orthodontic Treatment Months Count
Start: 10/31/2004
606Paid From Part A Medicare Trust Fund Amount
Start: 10/31/2004
607Paid From Part B Medicare Trust Fund Amount
Start: 10/31/2004
608Paid Service Unit Count
Start: 10/31/2004
609Participation Agreement
Start: 10/31/2004
610Patient Discharge Facility Type Code
Start: 10/31/2004
611Peer Review Authorization Number
Start: 10/31/2004
612Per Day Limit Amount
Start: 10/31/2004
613Physician Contact Date
Start: 10/31/2004
614Physician Order Date
Start: 10/31/2004
615Policy Compliance Code
Start: 10/31/2004
616Policy Name
Start: 10/31/2004
617Postage Claimed Amount
Start: 10/31/2004
618PPS-Capital DSH DRG Amount
Start: 10/31/2004
619PPS-Capital Exception Amount
Start: 10/31/2004
620PPS-Capital FSP DRG Amount
Start: 10/31/2004
621PPS-Capital HSP DRG Amount
Start: 10/31/2004
622PPS-Capital IME Amount
Start: 10/31/2004
623PPS-Operating Federal Specific DRG Amount
Start: 10/31/2004
624PPS-Operating Hospital Specific DRG Amount
Start: 10/31/2004
625Predetermination of Benefits Identifier
Start: 10/31/2004
626Pregnancy Indicator
Start: 10/31/2004
627Pre-Tax Claim Amount
Start: 10/31/2004
628Pricing Methodology
Start: 10/31/2004
629Property Casualty Claim Number
Start: 10/31/2004
630Referring CLIA Number
Start: 10/31/2004
631Reimbursement Rate
Start: 10/31/2004
632Reject Reason Code
Start: 10/31/2004
633Related Causes Code (Accident, auto accident, employment)
Start: 10/31/2004 | Last Modified: 10/17/2010
634Remark Code
Start: 10/31/2004
635Repriced Ambulatory Patient Group Code
Start: 10/31/2004
636Repriced Line Item Reference Number
Start: 10/31/2004
637Repriced Saving Amount
Start: 10/31/2004
638Repricing Per Diem or Flat Rate Amount
Start: 10/31/2004
639Responsibility Amount
Start: 10/31/2004
640Sales Tax Amount
Start: 10/31/2004
642Service Authorization Exception Code
Start: 10/31/2004
643Service Line Paid Amount
Start: 10/31/2004
644Service Line Rate
Start: 10/31/2004
645Service Tax Amount
Start: 10/31/2004
646Ship, Delivery or Calendar Pattern Code
Start: 10/31/2004
647Shipped Date
Start: 10/31/2004
648Similar Illness or Symptom Date
Start: 10/31/2004
649Skilled Nursing Facility Indicator
Start: 10/31/2004
650Special Program Indicator
Start: 10/31/2004
651State Industrial Accident Provider Number
Start: 10/31/2004
652Terms Discount Percentage
Start: 10/31/2004
653Test Performed Date
Start: 10/31/2004
654Total Denied Charge Amount
Start: 10/31/2004
655Total Medicare Paid Amount
Start: 10/31/2004
656Total Visits Projected This Certification Count
Start: 10/31/2004
657Total Visits Rendered Count
Start: 10/31/2004
658Treatment Code
Start: 10/31/2004
659Unit or Basis for Measurement Code
Start: 10/31/2004
660Universal Product Number
Start: 10/31/2004
661Visits Prior to Recertification Date Count CR702
Start: 10/31/2004
662X-ray Availability Indicator
Start: 10/31/2004
663Entity's Group Name. Note: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 02/11/2010
664Orthodontic Banding Date
Start: 10/31/2004
665Surgery Date
Start: 10/31/2004
666Surgical Procedure Code
Start: 10/31/2004
667Real-Time requests not supported by the information holder, do not resubmit
Start: 02/28/2005
668Missing Endodontics treatment history and prognosis
Start: 06/30/2005
669Dental service narrative needed.
Start: 10/31/2005
670Funds applied from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts
Start: 06/30/2006 | Last Modified: 02/28/2007
671Funds may be available from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts
Start: 06/30/2006 | Last Modified: 02/28/2007
672Other Payer's payment information is out of balance
Start: 10/31/2006
673Patient Reason for Visit
Start: 10/31/2006
674Authorization exceeded
Start: 10/31/2006
675Facility admission through discharge dates
Start: 10/31/2006
676Entity possibly compensated by facility. Note: This code requires use of an Entity Code.
Start: 10/31/2006 | Last Modified: 02/11/2010
677Entity not affiliated. Note: This code requires use of an Entity Code.
Start: 10/31/2006 | Last Modified: 02/11/2010
678Revenue code and patient gender mismatch
Start: 10/31/2006
679Submit newborn services on mother's claim
Start: 10/31/2006
680Entity's Country. Note: This code requires use of an Entity Code.
Start: 10/31/2006 | Last Modified: 02/11/2010
681Claim currency not supported
Start: 10/31/2006
682Cosmetic procedure
Start: 02/28/2007
683Awaiting Associated Hospital Claims
Start: 02/28/2007
684Rejected. Syntax error noted for this claim/service/inquiry. See Functional or Implementation Acknowledgement for details. (Note: Only for use to reject claims or status requests in transactions that were 'accepted with errors' on a 997 or 999 Acknowledgement.)
Start: 11/05/2007
685Claim could not complete adjudication in real time. Claim will continue processing in a batch mode. Do not resubmit.
Start: 01/27/2008
686The claim/ encounter has completed the adjudication cycle and the entire claim has been voided
Start: 01/27/2008
687Claim estimation can not be completed in real time. Do not resubmit.
Start: 01/27/2008
688Present on Admission Indicator for reported diagnosis code(s).
Start: 01/27/2008
689Entity was unable to respond within the expected time frame. Note: This code requires use of an Entity Code.
Start: 06/01/2008 | Last Modified: 02/11/2010
690Multiple claims or estimate requests cannot be processed in real time.
Start: 06/01/2008
691Multiple claim status requests cannot be processed in real time.
Start: 06/01/2008
692Contracted funding agreement-Subscriber is employed by the provider of services
Start: 09/21/2008
693Amount must be greater than or equal to zero. Note: At least one other status code is required to identify which amount element is in error.
Start: 01/25/2009
694Amount must not be equal to zero. Note: At least one other status code is required to identify which amount element is in error.
Start: 01/25/2009
695Entity's Country Subdivision Code. Note: This code requires use of an Entity Code.
Start: 01/25/2009 | Last Modified: 02/11/2010
696Claim Adjustment Group Code.
Start: 01/25/2009
697Invalid Decimal Precision. Note: At least one other status code is required to identify the data element in error.
Start: 07/01/2009
698Form Type Identification
Start: 07/01/2009
699Question/Response from Supporting Documentation Form
Start: 07/01/2009
700ICD10. Note: At least one other status code is required to identify the related procedure code or diagnosis code.
Start: 07/01/2009
701Initial Treatment Date
Start: 07/01/2009
702Repriced Claim Reference Number
Start: 11/01/2009
703Advanced Billing Concepts (ABC) code
Start: 01/24/2010
704Claim Note Text
Start: 01/24/2010
705Repriced Allowed Amount
Start: 01/24/2010
706Repriced Approved Amount
Start: 01/24/2010
707Repriced Approved Ambulatory Patient Group Amount
Start: 01/24/2010
708Repriced Approved Revenue Code
Start: 01/24/2010
709Repriced Approved Service Unit Count
Start: 01/24/2010
710Line Adjudication Information. Note: At least one other status code is required to identify the data element in error.
Start: 01/24/2010
711Stretcher purpose
Start: 01/24/2010
712Obstetric Additional Units
Start: 01/24/2010
713Patient Condition Description
Start: 01/24/2010
714Care Plan Oversight Number
Start: 01/24/2010
715Acute Manifestation Date
Start: 01/24/2010
716Repriced Approved DRG Code
Start: 01/24/2010
717This claim has been split for processing.
Start: 01/24/2010
718Claim/service not submitted within the required timeframe (timely filing).
Start: 01/24/2010
719NUBC Occurrence Code(s)
Start: 01/24/2010
720NUBC Occurrence Code Date(s)
Start: 01/24/2010
721NUBC Occurrence Span Code(s)
Start: 01/24/2010
722NUBC Occurrence Span Code Date(s)
Start: 01/24/2010
723Drug days supply
Start: 01/24/2010
724Drug dosage
Start: 01/24/2010
725NUBC Value Code(s)
Start: 01/24/2010
726NUBC Value Code Amount(s)
Start: 01/24/2010
727Accident date
Start: 01/24/2010
728Accident state
Start: 01/24/2010
729Accident description
Start: 01/24/2010
730Accident cause
Start: 01/24/2010
731Measurement value/test result
Start: 01/24/2010
732Information submitted inconsistent with billing guidelines. Note: At least one other status code is required to identify the inconsistent information.
Start: 01/24/2010
733Prefix for entity's contract/member number.
Start: 01/24/2010
734Verifying premium payment
Start: 06/06/2010
735This service/claim is included in the allowance for another service or claim.
Start: 06/06/2010
736A related or qualifying service/claim has not been received/adjudicated.
Start: 06/06/2010
737Current Dental Terminology (CDT) Code
Start: 06/06/2010
738Home Infusion EDI Coalition (HEIC) Product/Service Code
Start: 06/06/2010
739Jurisdiction Specific Procedure or Supply Code
Start: 06/06/2010
740Drop-Off Location
Start: 06/06/2010
741Entity must be a person. Note: This code requires use of an Entity Code.
Start: 06/06/2010
742Payer Responsibility Sequence Number Code
Start: 06/06/2010
743Entity’s credential/enrollment information. Note: This code requires use of an Entity Code.
Start: 10/17/2010
744Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.
Start: 10/17/2010
745Identifier Qualifier Note: At least one other status code is required to identify the specific identifier qualifier in error.
Start: 10/17/2010
746Duplicate Submission Note: use only at the information receiver level in the Health Care Claim Acknowledgement transaction.
Start: 10/17/2010
747Hospice Employee Indicator
Start: 10/17/2010
748Corrected Data Note: Requires a second status code to identify the corrected data.
Start: 10/17/2010
749Date of Injury/Illness
Start: 10/17/2010
750Auto Accident State or Province Code
Start: 10/17/2010 | Last Modified: 01/30/2011
751Ambulance Pick-up State or Province Code
Start: 10/17/2010 | Last Modified: 01/30/2011
752Ambulance Drop-off State or Province Code
Start: 10/17/2010 | Last Modified: 01/30/2011
753Co-pay status code.
Start: 01/30/2011
754Entity Name Suffix. Note: This code requires the use of an Entity Code.
Start: 01/30/2011
755Entity's primary identifier. Note: This code requires the use of an Entity Code.
Start: 01/30/2011
756Entity's Received Date. Note: This code requires the use of an Entity Code.
Start: 01/30/2011
757Last seen date.
Start: 01/30/2011
758Repriced approved HCPCS code.
Start: 01/30/2011
759Round trip purpose description.
Start: 01/30/2011
760Tooth status code.
Start: 01/30/2011
761Entity's referral number. Note: This code requires the use of an Entity Code.
Start: 01/30/2011
762Locum Tenens Provider Identifier. Code must be used with Entity Code 82 - Rendering Provider
Start: 01/20/2013
763Ambulance Pickup ZipCode
Start: 01/20/2013
764Professional charges are non covered.
Start: 06/02/2013
765Institutional charges are non covered.
Start: 06/02/2013
766Services were performed during a Health Insurance Exchange (HIX) premium payment grace period.
Start: 11/01/2013
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Box #21, ICD 10 entering on CMS 1500 new form

January 23, 2014, 1:27 am
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Item 21 - Enter the patient's diagnosis/condition. With the exception of claims submitted by ambulance suppliers (specialty type 59), all physician and nonphysician specialties (i.e., PA, NP, CNS, CRNA) use diagnosis codes to the highest level of specificity for the date of service. Enter the diagnoses in priority order. All narrative diagnoses for nonphysician specialties shall be submitted on an attachment.

Reminder: Do not report ICD-10-CM codes for claims with dates of service prior to October 1, 2014, on either the old or revised version of the CMS-1500 claim form.

For form version 08/05, report a valid ICD-9-CM code. Enter up to four diagnosis codes.

For form version 02/12, it may be appropriate to report either ICD-9-CM or ICD-10-CM codes depending upon the dates of service (i.e., according to the effective dates of the given code set).

• The “ICD Indicator” identifies the ICD code set being reported. Enter the applicable ICD indicator according to the following:

 Indicator Code Set 
 9 ICD-9-CM diagnosis
0 ICD-10-CM diagnosis

Enter the indicator as a single digit between the vertical, dotted lines.

• Do not report both ICD-9-CM and ICD-10-CM codes on the same claim form. If there are services you wish to report that occurred on dates when ICD-9-CM codes were in effect, and others that occurred on dates when ICD-10-CM codes were in effect, then send separate claims such that you report only ICD-9-CM or only ICD-10-CM codes on the claim. (See special considerations for spans of dates below.)

• If you are submitting a claim with a span of dates for a service, use the “from” date to determine which ICD code set to use.

• Enter up to 12 diagnosis codes. Note that this information appears opposite lines with letters A-L. Relate lines A- L to the lines of service in 24E by the letter of the line. Use the highest level of specificity. Do not provide narrative description in this field.

• Do not insert a period in the ICD-9-CM or ICD-10-CM code.
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Sample new CMS 1500 CLAIM form

February 19, 2014, 11:08 pm
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Now we can enter 12 DX in single claim.

See the below changes in the format of 21 BLOCK


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Date format in CMS 1500 forms

August 24, 2014, 2:19 am
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Required Data Element Requirements

1 - Paper Claims
The following instruction describes certain data element formatting requirements to be followed when reporting the calendar year date for the identified items on the F9+o203 rm CMS-1500:
/
• If birth dates are furnished in the items stipulated below, then these items must contain 8-digit birth dates (MMDDCCYY). This includes 2-digit months (MM) and days (DD), and 4-digit years (CCYY).
Form CMS-1500 Items Affected by These Reporting Requirements:

Item 3 - Patient’s Birth Date
Item 9b - Other Insured’s Date of Birth
Item 11a - Insured’s Date of Birth
Note that 8-digit birth dates, when provided, must be reported with a space between month, day, and year (i.e., MM_DD_CCYY). On the Form CMS-1500, the space between month, day, and year is delineated by a dotted, vertical line.

If a birth date is provided in items 3, 9b, or 11a, and is not in 8-digit format, carriers must return the claim as unprocessable. Use remark code N329 on the remittance advice. For formats other than the remittance, use code(s)/messages that are consistent with the above remark codes.

If carriers do not currently edit for birth date items because they obtain the information from other sources, they are not required to return these claims if a birth date is reported in items 3, 9b, or 11a. and the birth date is not in 8-digit format. However, if carriers use date of birth information on the incoming claim for processing, they must edit and return claims that contain birth date(s) in any of these items that are not in 8-digit format.

For certain other Form CMS-1500 conditional or required date items (items 11b, 14, 16, 18, 19, or 24A.), when dates are provided, either a 6-digit date or 8-digit date may be provided.

If 8-digit dates are furnished for any of items 11a., 14, 16, 18, 19, or 24A. (excluding items 12 and 31), carriers must note the following:
• All completed date items, except item 24A., must be reported with a space between month, day, and year (i.e., MM_DD_CCYY). On the Form CMS-1500, the space between month, day, and year is delineated by a dotted, vertical line;

• Item 24A. must be reported as one continuous number (i.e., MMDDCCYY), without any spaces between month, day, and year. By entering a continuous number, the date(s) in item 24A. will penetrate the dotted, vertical lines used to separate month, day, and year. Carrier claims processing systems will be able to process the claim if the date penetrates these vertical lines. However, all 8-digit dates reported must stay within the confines of item 24A;

• Do not compress or change the font of the “year” item in item 24A. to keep the date within the confines of item 24A. If a continuous number is furnished in item 24A. with no spaces between month, day, and year, you will not need to compress the “year” item to remain within the confines of item 24A.;

• The “from” date in item 24A. must not run into the “to” date item, and the “to” date must not run into item 24B.;

• Dates reported in item 24A. must not be reported with a slash between month, day, and year; and

• If the provider of service or supplier decides to enter 8-digit dates for any of items 11b, 14, 16, 18, 19, or 24A. (excluding items 12 and 31), an 8-digit date must be furnished for all completed items. For instance, you cannot enter 8-digit dates for items 11b, 14, 16, 18, 19 (excluding items 12 or 31), and a 6-digit date for item 24A. The same applies to those who wish to submit 6-digit dates for any of these items.
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New Physician Specialty Code for Interventional Cardiology

September 24, 2014, 12:10 am
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This MLN Matters® Article is intended for physicians, non-physician practitioners, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.

CR 8812, from which this article is taken, provides notice that the Centers for Medicare & Medicaid Services (CMS) is establishing a new physician specialty code for Interventional Cardiology. The CR is also changing the description of specialty code 62, and updating the names associated to specialty codes 88 and 95. Make sure your billing staffs are aware of these changes.

Physicians who enroll in the Medicare program self-designate their Medicare physician specialty on the Medicare enrollment application (CMS-855B) or via the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS). Non-physician practitioners who enroll with Medicare are assigned a Medicare specialty code. These Medicare physician/non-physician practitioner specialty codes describe the specific/unique types of medicine that physicians and non-physician practitioners (and certain other suppliers) practice. They become associated with the claims that physician or non-physician practitioners submit; and are used by CMS for programmatic and claims processing purposes.


CR 8812 establishes a new physician specialty code for Interventional Cardiology (C3). CR8812 is also removing the word “Clinical” from the description of specialty code 62 (Psychologist (Billing Independently)), and is changing the description of specialty code 88 to “Unknown Provider,” and of specialty code 95 to “Unknown Supplier”. The changes to the descriptions for codes 88 and 95 align their names with their intended usages.
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NPI AND PTAN Difference and Relationship - complete review

October 10, 2014, 12:50 am
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This article explains the difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN). There are no policy changes in this article.

All providers and suppliers who provide services and bill Medicare for services provided to Medicare beneficiaries must have an NPI. Upon application to a Medicare Administrative Contractor (MAC), the provider or supplier will also be issued a
Provider Transaction Access Number (PTAN). While only the NPI can be submitted on claims, the PTAN is a critical number directly linked to the provider or supplier’s NPI.


Providers and suppliers receiving requests to revalidate their enrollment information have asked the Centers for Medicare & Medicaid Services (CMS) to clarify the differences between the NPI and the PTAN.

National Provider Identifier (NPI)

The NPI is a national standard under the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification provisions.

• The NPI is a unique identification number for covered health care providers.
• The NPI is issued by the National Plan and Provider Enumeration System (NPPES).
• Covered health care providers and all health plans and health care clearinghouses must use the NPI in the administrative and financial transactions (for example, insurance claims) adopted under HIPAA.

• The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). The NPI does not carry information about healthcare providers, such as the state in which they live or their medical specialty. This reduces the chances of insurance fraud.

• Covered providers and suppliers must share their NPI with other suppliers and providers, health plans, clearinghouses, and any entity that may need it for billing purposes.

Since May 23, 2008, Medicare has required that the NPI be used in place of all legacy provider identifiers, including the Unique Physician Identification Number (UPIN), as the unique identifier for all providers, and suppliers in HIPAA standard transactions.

You should note that individual health care providers (including physicians who are sole proprietors) may obtain only one NPI for themselves (Entity Type 1 Individual). Incorporated individuals should obtain one NPI for themselves (Entity Type 1
Individual) if they are health care providers and an additional NPI(s) for their corporation(s) (Entity Type 2 Organization). Organizations that render health care or furnish health care supplies may obtain NPIs (Entity Type 2 Organization) for their organizations and their subparts (if applicable).

For more information about the NPI, visit the NPPES website at https://nppes.cms.hhs.gov/NPPES/Welcome.do on the CMS website.

Provider Transaction Access Number (PTAN)

A PTAN is a Medicare-only number issued to providers by MACs upon enrollment to Medicare. When a MAC approves enrollment and issues an approval letter, the letter will contain the PTAN assigned to the provider.

** The approval letter will note that NPI must be used to bill the Medicare program and that PTAN will be used to autheniticate the provider when using MAC self help tools such as IVR , internet portal , online application etc.

** The PTAN's use should generally be limited to the provider's contacts with their MAC


Where can I find my PTAN?

You can find your PTAN by doing any one of the following:

1. View the letter sent by your MAC when your enrollment in Medicare was approved.

2. Log into Internet-based PECOS. Click on the “My Enrollments” button and then “View Enrollments”. Locate the applicable enrollment and click on the “View Medicare ID Report” link which will list all of the provider or supplier’s active
PTANs in one report.

3 The provider (or, in the case of an organizational provider, an authorized or delegated official) shall send a signed written request on company letterhead to your MAC; include your legal name/legal business name, national provider identifier
(NPI), telephone and fax numbers.


Relationship of the NPI to the PTAN

The NPI and the PTAN are related to each other for Medicare purposes. A provider must have one NPI and will have one, or more, PTAN(s) related to it in the Medicare system, representing the provider’s enrollment. If the provider has relationships with one or more medical groups or practices or with multiple Medicare contractors, separate PTANS are generally assigned.

Together, the NPI and PTAN identify the provider, or supplier in the Medicare program. CMS maintains both the NPI and PTAN in the Provider Enrollment Chain & Ownership System (PECOS), the master provider and supplier enrollment system.


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Electronic Billing Guide: Submitting Medical Documentation for Part A/B 5010 Electronic Claims

November 7, 2014, 1:38 am
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Submitting Medical Documentation For Part A/B 5010 Electronic Claims

Under the Health Insurance Portability and Accountability Act (HIPAA), claims for reimbursement by the Medicare Program must be submitted electronically, except where waived, even for claims with attachments. The process for accepting medical documentation and attaching it to the electronic claim has been improved due to our imaging system. The Claim Supplemental Information segment (PWK) is used whenever paper documentation has been sent for an electronic claim. When sending an electronic claim that contains an attachment, follow these rules to submit the attachment for your electronic claim:

Maintain the appropriate medical documentation on file for electronic (and paper) claims.
Complete the Medicare Part A Fax/Mail Cover Sheet * or the Medicare Part B Fax/Mail Cover Sheet * form. For accurate processing of your claim(s), please complete all requested information in capital letters and avoid contact with the edge of the boxes.

Important tips to keep in mind when faxing medical records for electronic claims:
•    Only send medical documentation when necessary for the adjudication of procedures/services that are unusual or require such documentation on a pre-payment basis.
•    The narrative field on the claim is to be utilized in situations where sufficient information for the documentation of a procedure/modifier can be provided without sending the medical records. When additional information cannot be contained in the narrative of the claim, additional documentation (medical records) may be submitted via mail or fax.
•    Only fax documentation for one patient per cover sheet. The cover sheet is for Part A or B electronic claims.
•    Clearly write the: Attachment Control Number, Internal Control Number (ICN/DCN), Patient Name, Health Insurance Claim (HIC) Number, Date of Service, Total Claim Billed Amount, National Provider Identification (NPI) Number, Contact Information, and State Where Services Were Provided on the cover sheet.  Failure to submit all items requested will result in documentation being returned and could delay claim processing.
•    The fax/mail cover sheets are not to be modified.
•    Only the first iteration of the PWK, at either the claim level and/or line level, will be considered for adjudication.
•    Submitters must send ALL relevant PWK data at the same time for the same claim.
•    After submitting the electronic claim, locate the ICN/DCN number on the 277CA claims acknowledgement report.  The ICN/DCN is located in the 2200D REF segment.
•    Fax the cover sheet and medical documentation to (877) 439-5479. You may fax documentation any time after claim submission, including the same day. Faxing is available 24 hours a day, 7 days a week. Faxes should be sent within seven calendar days of your electronic claim submission.
Novitas Solutions strongly recommends faxing your medical documentation. If you are not able to fax your documentation, mail the Medicare Part A Fax/Mail Cover Sheet * or the Medicare Part B Fax/Mail Cover Sheet * and all pertinent medical documentation within ten calendar days of your electronic claim submission.

In the Claim Supplemental Information Segment (PWK) of the electronic claim:
•    Select the appropriate Report Type Code for the medical documentation. For information on what codes are needed in the PWK segment.
•    Use the By Fax or By Mail option for the Attachment Transmission Code
•    Enter AC for the Identification Code Qualifier
•    Report the Attachment Control Number - This number may be assigned by your software or can be any number you chose including the patient account number or other identifying number.
Note: Only send medical documentation when necessary for the adjudication of procedures/services that are unusual or require such documentation on a pre-payment basis.
Technically Speaking, Claim Supplemental Information (PWK) is reported as follows:

Data Element    Segment
Attachment Report Type Code    2300 or 2400 - PWK01
Attachment Transmission Code    2300 or 2400 - PWK02
Identification Code Qualifier    2300 or 2400 - PWK05
Attachment Control Number    2300 or 2400 - PWK06
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provider identifying qualifiers box 17

November 11, 2014, 3:40 am
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This MLN Matters® Article is intended for physicians and other providers submitting claims to Medicare contractors (carriers, A/B Medicare Administrative Contractors (A/B MACs), and Durable Medical Equipment Medicare Administrative Contractors
(DME/MACs)) for services provided to Medicare beneficiaries.

This change request (CR) 8509 revises the current CMS 1500 claim form instructions to
reflect the revised CMS 1500 claim form, version 02/12.

The National Uniform Claim Committee (NUCC) recently revised the CMS 1500 claim form. On June 10, 2013, the White House Office of Management and Budget (OMB) approved the revised form, 02/12. The revised form has a number of changes. Those most notable for Medicare are new indicators to differentiate between ICD-9 and ICD-10 codes on a claim, and qualifiers to identify whether certain providers are being identified as having performed an ordering, referring, or supervising role in the furnishing of the service. In addition, the revised form uses letters, instead of numbers, as diagnosis code pointers, and expands the number of possible diagnosis codes on a claim to 12.The qualifiers that are appropriate for identifying an ordering, referring, or supervising role are as follows:

• DN - Referring Provider
• DK - Ordering Provider
DQ - Supervising Provider

Providers should enter the qualifier to the left of the dotted vertical line on item 17.
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What are 837 I format and cms 1450 claim

December 15, 2014, 11:03 pm
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The 837I (Institutional) is the standard format used by institutional providers to transmit health care claims electronically. The Form CMS-1450, also known as the UB-04, is the standard claim form to bill Medicare Fee-For-Service (FFS) Contractors when a paper claimis allowed. In addition to billing Medicare, the 837I and Form CMS-1450 may be suitable for billing various
government and some private insurers.

Data elements in the Centers for Medicare & Medicaid Services (CMS) uniform electronic billing specifications are consistent with the hard copy data set to the extent that one processing system can handle both. CMS designates the form as the Form CMS-1450 and the form is referred to throughout this fact sheet as the CMS-1450.

Institutional providers include hospitals, Skilled Nursing Facilities (SNFs), End Stage Renal Disease (ESRD) providers, Home Health Agencies (HHAs), hospices, outpatient rehabilitation clinics, Comprehensive Outpatient Rehabilitation Facilities (CORFs), Community Mental Health Centers (CMHCs), Critical Access Hospitals (CAHs), Federally Qualified Health Centers (FQHCs), histocompatibility laboratories, Indian Health Service (IHS) facilities, organ procurement organizations, Religious Non-Medical Health Care Institutions (RNHCIs), and Rural Health Clinics (RHCs).

ANSI ASC X12N 837I

The American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12N 837I (Institutional) Version 5010A2 is the current electronic claim version. To learn more, visit the ASC X12 website on the Internet.

ANSI = American National Standards Institute
ASC = Accredited Standards Committee
X12N = Insurance section of ASC X12 for the health insurance industry’s administrative transactions
837 = Standard format for transmitting health care claims electronically
I = Institutional version of the 837 electronic format
Version 5010A2 = Current version of the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards for institutional providers.
The National Uniform Billing Committee (NUBC) makes their UB-04 manual available through their website. This manual contains the updated specifications for the data elements and codes included on the CMS-1450 and used in the 837I transaction standard. Medicare FFS Contractors may include a crosswalk between the ASC X12N 837I and the CMS-1450 on their websites

When Does Medicare Accept a Hard Copy Claim Form?

Initial claims for payment under Medicare must be submitted electronically unless an institutional provider qualifies for a waiver or exception from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims.

Before submitting a hard copy claim, providers should self-assess to determine if they meet one
or more of the ASCA exceptions. For example, institutional providers that have fewer than 25 Full-Time Equivalent (FTE) employees and bill a Medicare FFS Contractor are considered to be small and might therefore qualify to be exempt from Medicare electronic billing requirements. If an institutional provider meets an exception, there is no need to submit a waiver request.

There are other situations when the ASCA electronic billing requirement could be waived for some or all claims, such as if disability of all members of an institutional provider’s staff prevents use of a computer for electronic submission of claims. Institutional providers must obtain Medicare pre-approval to submit paper claims in these situations by submitting a waiver request to their Medicare FFS Contractor.

Timely Filing

The timely filing period for both paper and electronic Medicare claims is 12 months, or one calendar year, after the date of service.

Claims are denied if they arrive after the deadline date. When a claim is denied for having been filed after the timely filing period, such a denial does not constitute an initial determination. As such, the determination that a claim was not filed timely is not subject to appeal.

In general, the start date for determining the 12-month timely filing period is the date of service or ‘From’ date on the claim. Medicare uses the line item ‘Through’ date to determine the date of service for claims filing timeliness for claims that include span dates of service (i.e., a ‘From’ and ‘Through’ date span on the claim).
Medicare regulations allow exceptions to the 12-month time limit for filing claims.

Where to Submit FFS Claims

Claims for services must be submitted to the appropriate Medicare FFS Contractor. Contact the Medicare FFS Contractor by referencing the
Provider Compliance Group Interactive Map on the CMS website. Medicare beneficiaries cannot be charged for completing or filing a claim. Providers may be subject to penalty for violations.

If a beneficiary is enrolled in a Medicare Advantage (MA) Plan, claims should not be submitted to the Medicare FFS Contractor; the beneficiary’s MA Plan is responsible for claims processing. CMS provides a list of MA claims processing contacts on the CMS website.

Medicare Secondary Payer (MSP)
MSP provisions apply to situations when Medicare is not the beneficiary’s primary health insurance coverage and ensure that Medicare does not pay for services and items that certain other health insurance or coverage is primarily responsible for paying. For more information, reference the “Medicare Secondary Payer for Provider, Physician, and Other Supplier Billing Staff” fact sheet available through the MLN “Catalog of Products” on the CMS website. The Medicare Secondary Payer web page offers information on MSP laws and the various methods employed by CMS to gather data on other insurance that may be primary to Medicare.



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Face-to-Face Encounters and Certification for Home Health Care and Physician Documentation Requirements (G0180 and G0179)

January 12, 2015, 1:36 am
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Physician play a key role in documenting eligibility and medical necessity for home health care for Medicare beneficiaries. If you certify the need for home health care for any of your patients, we encourage you to review this article carefully. As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face (FTF) encounters with your patients regarding home health care and certification of need. Medicare provides payment for physician initial and re-certification of Medicare-covered home health services under a home health plan of care (G0180 and G0179).

Background: Qualifying Criteria for the Medicare Home Health Benefit
To qualify for the Medicare home health benefit, under section 1814(a)(2)(C) and 1835(a)(2)(A) of the Social Security Act, Medicare beneficiaries must meet all of the following requirements:
•    Be confined to the home;
•    Under the care of a physician;
•    Receiving services under a plan of care established and periodically reviewed by a physician;
•    Be in need of skilled nursing care on an intermittent basis or physical therapy or speech-language pathology; or
•    Have a continuing need for occupational therapy.
The Centers for Medicare & Medicaid Services (CMS) further defines “intermittent,” for purposes of this benefit, as “skilled nursing or home health aide services furnished any number of days per week as long as they are furnished (combined) less than 8 hours each day and 28 or fewer hours each week (or, subject to review on a case-by-case basis as to the need for care, less than 8 hours each day and fewer than 35 hours per week).” CMS also defines home confinement; we strongly encourage you to review the definition of home confinement in its entirety in the CMS Medicare Benefit Policy Manual (the web address to access this manual is provided at the end of this letter).

Major Documentation Errors
Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a nationwide, significant, and continuing increase in denials related to documentation for the FTF.  The most common error is insufficient documentation of clinical findings by the physician/non-physician practitioner (NPP) to show:
•    The encounter was related to the primary reason for home care
•    How the patient’s condition supports the patient’s homebound status; or
•    How the patient’s condition supports the need for skilled services
Acceptable FTF documentation does not have to be lengthy or overly detailed.  However, the FTF documentation must show the reason skilled service is necessary for the treatment of the patient’s illness or injury, based on the physician’s clinical findings during the face-to-face encounter, and specific statements regarding why the patient is homebound.
Following are examples of FTF documentation that, used alone, are considered insufficient documentation.

Homebound StatusNeed for Skilled Services
“Functional decline”“Family is asking for help”
“Dementia” or “confusion”“Continues to have problems”
“Difficult to travel to doctor’s office”List of tasks for nurse to do
“Unable to leave home”/ “Unable to drive“Patient unable to do wound care”
“Weak”“Diabetes”
“Status post total hip”


Examples of appropriate documentation include:
•    “Wound care to left great toe. No s/s of infection, but patient remains at risk due to diabetic status.  Skilled nurse visits to perform wound care and assess wound status.  Patient on bed to chair activities only.”
•    “Lung sounds coarse throughout. Patient finished antibiotic therapy today for pneumonia, and to see pulmonologist tomorrow for follow up due to COPD and emphysema.  Short of breath with talking and ambulation of 1-2 feet.  Nurse to assess respiratory status for s/s of recurring infection/ changes in respiratory status.”
•    “CHF, CLL, weakness, 3+ edema in R & L legs; needs cardiac assessment, monitoring of signs & symptoms of disease, and patient education; homebound due to shortness of breath with minimal exertion, e.g., walking 5 feet.”
•    “Status post right total hip replacement. Needs physical therapy to restore ability to walk without assistance. Homebound temporarily due to requiring a walker, inability to negotiate uneven surfaces and stairs, inability to walk greater than 5 - 10 feet before needing to rest. ”
In all cases, your documentation must be specific to that patient’s condition at the time of your encounter with him or her.

Who May Document the FTF Encounter?
The FTF encounter must be performed by the certifying physician, a physician who cared for the patient in an acute or post-acute facility during a recent acute or post-acute stay and has privileges at the facility, or a qualified nonphysician practitioner (NPP) working in conjunction with the certifying physician.  An NPP in an acute or post-acute facility is able to perform the FTF encounter in collaboration with or under the supervision of the physician who has privileges and cared for the patient in the acute or post-acute facility.  That NPP can then report the FTF encounter to the certifying physician.
Medicare guidelines also contain specific documentation requirements:

The certifying physician must document that the FTF visit took place, regardless of who performed the encounter.
If the FTF encounter was not performed by the certifying physician, the NPP or physician who cared for the patient and performed the FTF must provide the face-to-face record of the FTF encounter to the certifying physician.  NPPs performing the FTF encounter in an acute/post-acute facility must inform the physician they are collaborating with, or under the supervision of, so that the physician can inform the certifying physician of the clinical findings of the FTF.
The certifying physician cannot merely co-sign the encounter documentation if performed by an NPP.  He or she must complete/sign the form or a staff member from his or her office may complete the form from the physician’s encounter notes, which the certifying physician would then sign.
The FTF encounter documentation must be clearly titled, dated, and signed by the certifying physician before the home health agency submits a claim to Medicare and must include:
The date of the FTF encounter, and
Clinical findings to support that the encounter is related to the primary reason for home care, the patient is homebound, and in need of Medicare covered home health services.
Finally, because the FTF encounter is a requirement for payment, when the FTF encounter requirements as outlined above are not met, the home health agency’s entire claim is denied.  For cases in which the beneficiary’s condition otherwise warrants Medicare coverage of skilled home health services, but FTF encounter documentation is insufficient, the beneficiary’s ability to receive this skilled care may be jeopardized.

Home health agencies may ask you to provide supporting documentation from your medical records to ensure that Medicare will cover home health services. You are permitted, and strongly encouraged, to provide this documentation, the disclosure of which is permitted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). No specific authorization is required from your patients in order to do this. Also, please note that you may not charge the home health agency for providing this information. We ask you to work in partnership with these agencies so they can provide appropriate and medically necessary care for your homebound patients.
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CMS-1500 (02/12) data element requirements - all field update

February 8, 2015, 12:50 am
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The following information discusses the conditions and requirements of the item fields within the CMS-1500 (02/12) paper claim form.

The National Uniform Claim Committee (NUCC) has created a presentation that reviews the changes to the revised form in detail. Click here  to view the NUCC presentation on the CMS-1500 (02/12) paper claim form.

Status Key:
R = Completion of this item is required by Medicare for every claim
C = Completion of this item is conditionally required based on certain circumstances
NR = Completion of this item is not required by Medicare Claims missing, or containing incomplete, or invalid information for any required or conditionally required item will be returned as unprocessable.

Note: Providers can utilize the First Coast Service Options Inc. (First Coast) PC-ACE Pro32™ software to submit claims electronically. PC-ACE Pro32™ software has built-in edits to avoid submitting claims without required information being included. Some item numbers contain links to

 Item Number    Item Description and Guidance    Requirement Status
1    Type of insurance    R
1a  Patient’s Medicare Health Insurance Claim (HIC) number    R
2  Enter the patient’s last name, first name, and middle initial (if any), as shown on patient’s Medicare card.    R
3    Enter the patient’s eight digit birth date (MM/DD/CCYY) and sex.    R
4    Insured’s name
(Complete item only if there is insurance primary to Medicare. Complete this item only when items 6, 7, and 11a-c are completed.)    C
5    Patient’s mailing address, city, state, and phone number    R
6    Check appropriate box for patient’s relationship to insured.
(Complete item only if there is insurance primary to Medicare. Complete this item only when items 4, 7, and 11a-c are completed.)    C
7    Insured’s address and telephone number.
Note: When address is the same as patient’s, enter the word SAME.
(Complete item only if there is insurance primary to Medicare. Complete this item only when items 4, 6, and 11a-c are completed.)    C
8    Leave blank -- Medicare Part B Providers are not required to complete.    NR
9-9d    Medigap information (Leave Items 9b and 9c blank)    C
10a-c    Employment/accident indicators    R
10d    Medicaid ID  C
11    Primary insurance policy number
Note: Enter the word NONE if Medicare is primary    R
11a-c    Insured’s birth date, employer, plan name (Item 11b -- provide this information to the right of the vertical line.)    C
11d    Another health benefit plan
Leave blank -- Medicare Part B Providers are not required to complete.    NR
12    Patient’s signature and date    R
13    Patient signature -- Medigap authorization
Note: Must be completed if information contained in 9-9d.    C
14    Date of current illness, injury, or pregnancy
Note: Although space for a qualifier is included, Medicare does not use this information; do not enter a qualifier in item 14.    C
15    Leave blank -- Medicare Part B Providers are not required to complete.    NR
16    If patient is employed, enter dates patient will be unable to work in current occupation.    C
17    Enter the name and qualifier of the referring, ordering or supervising physician if the item or service was ordered, supervised or referred by a physician.
• The qualifiers appropriate for identifying an ordering, referring, or supervising role are as follows:
• DN -- referring provider
• DK -- ordering provider
• DQ -- supervising provider
• Enter the qualifier to the left of the dotted vertical line on item 17.
Note: Claims submitted with a national provider identifier (NPI) and without one of the qualifiers notated above or an invalid qualifier will be returned as an unprocessable claim (RUC).
See Claim completion FAQs on the First Coast provider website for additional details for reporting referring/ordering providers.
See also the Ordering/referring provider FAQs for additional guidance.    C
Required if services are ordered, referred or supervised
17a   DO NOT complete    NR
17b   If the service is referred or ordered, enter the national provider identifier (NPI) of the referring/ordering individual provider only.
(Click here to verify the provider's NPI is eligible to order or refer services.)    C
Required if services are ordered, referred or supervised
18    Hospitalization dates    C
19    Additional claim information
See CMS IOM Pub 100-04, Chapter 26, Section 10.4  for guidance on completion of Item 19    C
20    Outside lab
See Claim completion FAQs on the First Coast provider website for additional details for reporting purchased services.    C
21
Report up to twelve primary diagnosis codes
• For dates of service prior to October 1, 2014 -- report ICD-9-CM codes. Enter the ICD indicator 9 as a single digit between the vertical, dotted lines.
• For dates of service on and after October 1, 2014 -- report ICD-10-CM codes. Enter the ICD indicator 0 as a single digit between the vertical, dotted lines.
• If submitting a claim with a span of dates for a service, use the “from” date to determine which ICD code set to use.    R
22    Leave blank -- Medicare Part B Providers are not required to complete.    NR
23    Prior authorization number     C
24A    Date(s) of service (DOS)    R
24B
Place of service (POS)
See CMS IOM Pub 100-04, Chapter 26, Section 10.5  for codes and definitions.    R
24C    Leave blank -- Medicare Part B Providers are not required to complete.    NR
24D    Procedure code/applicable modifiers   R
24E-Diagnosis pointer
Note: the reference will be a letter from A-L. This information appears opposite the diagnosis codes in Item 21. Relate lines A- L to lines of service in 24E by the letter of the line.     R
24F    Charge (in dollars) for service    R
24G    Days/Units    R
24H    Leave blank -- Medicare Part B Providers are not required to complete.    NR
24I - Leave blank -- Medicare Part B Providers are not required to complete.    NR
24J-Enter the NPI of the rendering provider in the lower non-shaded portion.
Do not report anything in the upper shaded portion of item 24J.    C
25    Federal tax identification number (TIN)    C
26    Patient’s account number    C
27    Assignment
See CMS IOM Pub 100-04, Chapter 1, Section 30.3.1  for list of provider and claim types for which assignment must always be accepted.    R
28    Total Charges    R
29    Enter amount collected from patient, if any.
Note: Please review When not to show patient paid amounts on claims article before collecting payments from patients.
C
30    Leave blank -- Medicare Part B Providers are not required to complete.    NR
31    Provider signature and date
Note: "Signature on File" and/or a computer generated signature are acceptable. See section 10.4 Item 32  for details R
32-For services payable under the Medicare Physician Fee Schedule (MPFS) and anesthesia services:
Name, address and ZIP of location where services were rendered for all locations.
Note: As of January 1, 2011, all locations (including patient's home) must be reported.    R
32a-If reporting anti-markup services (formerly purchased diagnostic services), enter the NPI of the provider who performed the service.
Note: DO NOT report for providers outside of local jurisdiction. Instead, you are required to report the NPI of the provider who purchased the service.    C
32b-DO NOT complete    NR
33-Billing provider’s name, address, ZIP and telephone number    R
33a-Enter the NPI of the billing provider or group.    R
33b -DO NOT complete    NR

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EHR Incentive Program: How to Report Once in 2014 for Medicare Quality Reporting Programs

March 1, 2015, 8:33 pm
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Providers participating in the 2014 Physician Quality Reporting System (PQRS) program may be eligible to report their quality data one time only to earn credit for multiple Medicare quality reporting programs. Individual eligible professionals and group practices will be able to report once on a single set of clinical quality measures (CQMs) and satisfy some of the various requirements of several of the following programs, depending on eligibility:

•    PQRS
•    Value-Based Payment Modifier (VM)
•    Medicare Electronic Health Record (EHR) Incentive Program
•    Medicare Shared Savings Program Accountable Care Organization (ACO)
•    Pioneer ACO
•    Comprehensive Primary Care Initiative (CPCI)

CMS aligned some of the reporting requirements for these programs starting in 2014 to reduce the burden of data collection. Those eligible professionals who choose to report once will reap several benefits:
•    Earn the 2014 PQRS incentive and avoid the 2016 PQRS payment adjustment.
•    Satisfy the CQM requirements of the Medicare EHR Incentive Program.
•    Satisfy requirements for the 2016 VM, ACO, and/or CPCI, if eligible.
Note: aligned reporting options are only available to eligible professionals beyond their first year of participation in the Medicare EHR Incentive Program.

How to Report Once
Individual eligible professionals and group practices must submit a full year (January 1 through December 31, 2014) of data to receive credit for the various programs. The following resources will help explain how providers can report their quality data one time for 2014 participation in applicable quality programs:

•    Reporting Once Interactive Tool: Provides reporting guidance based on how the eligible professional plans to participate in PQRS in 2014.
•    eHealth University Reporting Once Module: Explains how to report quality measures one time during the 2014 program year and satisfy quality reporting requirements PQRS, the Medicare EHR Incentive Program, the VM, and ACOs.
•    2014 CQM Electronic Reporting Guide: Provides an overview of 2014 CQMs and options for reporting them to CMS.
2014 QRDA III SEVT Testing Available
The Submission Engine Validation Tool (SEVT) for 2014 Quality Reporting Document Architecture (QRDA) III submission is available on the QualityNet Portal. CMS recommends QRDA submitters and certified EHR technology vendors use this tool for 2014 submission testing.
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Medicare coverage on Seasonal Flu Vaccinations

March 10, 2015, 8:47 pm
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Generally, Medicare Part B covers one flu vaccination and its administration per flu season for beneficiaries without co-pay or deductible. Now is the perfect time to vaccinate beneficiaries.
Health care providers are encouraged to get a flu vaccine to help protect themselves from the flu and to keep from spreading it to their family, co-workers, and patients.
Note: The flu vaccine is not a Part D-covered drug.

This recurring update notification provides the payment allowances for the following seasonal influenza virus vaccines, when payment is based on 95 percent of the Average Wholesale Price (AWP).
CPT 90655 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
CPT 90656 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
CPT 90657 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
CPT 90661 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
CPT 90685 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
CPT 90686 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
CPT 90687 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
CPT 90688 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
HCPCS Q2035 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
HCPCS Q2036 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
HCPCS Q2037 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
HCPCS Q2038 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015

Payment for the following CPT or HCPCS codes may be made if your MAC determines its
use is reasonable and necessary for the beneficiary, during the effective dates indicated
below:
CPT 90654 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
CPT 90662 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
CPT 90672 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
CPT 90673 Payment allowance is pending. Effective dates: 8/1/2014 - 7/31/2015
HCPCS Q2039 Flu Vaccine Adult - Not Otherwise Classified payment allowance is to be
determined by the local claims processing contractor with effective dates of 8/1/2014 -
7/31/2015.

Payment allowances for codes for products that have not yet been approved will be provided
when the products have been approved and pricing information becomes available to CMS.
The payment allowances for pneumococcal vaccines are based on 95 percent of the AWP
and are updated on a quarterly basis via the Quarterly Average Sales Price (ASP) Drug
Pricing Files. The Medicare Part B payment allowance limits for influenza and pneumococcal vaccines are 95 percent of the AWP as reflected in the published compendia except where the vaccine is furnished in a hospital outpatient department, Rural Health Clinic (RHC), or Federally
Qualified Health Center (FQHC). Where the vaccine is furnished in the hospital outpatient
department, RHC, or FQHC, payment for the vaccine is based on reasonable cost.

Annual Part B deductible and coinsurance amounts do not apply. All physicians, non-physician practitioners, and suppliers who administer the influenza virus vaccination and the pneumococcal vaccination must take assignment on the claim for the vaccine.
Note: MACs will not search their files either to retract payment for claims already paid or to retroactively pay claims prior to the implementation date of CR8890. However, they will adjust claims that you bring to their attention.
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