Instruction and Guide: correct process of claim submission
correct process of claim submissionGeneral ProceduresVerify eligibility through the Voice Response System (VRS), Internet, Provider Electronic Solutions or swipe card reader.• File claims within time...
View ArticleMedicare Coverage Rules: Items and Services Outside the U.S. and More
Items and Services Furnished Outside the United States (U.S.) - MedicareMost items and services furnished or delivered outside the U.S. are not covered, including when the beneficiary was within the...
View ArticleUnderstanding CMS 24: Reporting Requirements for Drugs and Medical Supplies
CMS 24 (Unnamed Shaded Area)Description24 (Unnamed Shaded Area)Enter the following information in the shaded area of Lines 1-6from the beginning of 24A to the end of 24G for up to 61characters.For...
View ArticleUB-04 Provider Type Identification & NPI Submission Guidelines
UB 04 - Provider Type identifying field instruction,55-56 Provider TypeThis identifies providers that require special handling. Enter one of the following codes as appropriate.00 or blanks = Short...
View ArticleClaims Processing and Payment (PCIP) program
A. General OverviewIncentive payments will be made on a quarterly basis and shall be equal to 10 percent of the amount paid for such services under the Medicare Physician Fee Schedule (PFS) for those...
View ArticleOptimizing Assistant Surgeon Claims and Erythropoietin Submission
Assistant surgeons or surgical assistants claim submission requirementsThe practice of directing or using non-participating providers significantly increases the costs of services for our members. As...
View ArticleSubmitting Laboratory Claims: Requirements and NPI Inclusion
How to submit claim for Laboratory serviceLaboratory claim submission requirementMany UnitedHealthcare benefit plan designs exclude from coverage outpatient diagnostic services that were not ordered...
View ArticleDemystifying Single Carrier TPR Codes in Medical Billing
Single carrier TPR codesUD Service under deductibleNC Service not covered by insurance policyPN Patient not covered by insurance policyIC Insurance coverage canceled/terminatedIL Insurance lapsed or...
View ArticleDemystifying Carrier Receipted Bill: Definition and Impact
Carrier Receipted Bill - DefinitionA receipted bill is a written acknowledgment by a person or organization furnishing specified covered services, which states that payment has been made for all...
View ArticleUnderstanding CMS 1500 Claim Errors and Corrections
CMS 1500 - Claim errorClaim Errors“Unprocessable claims” is a term used by Medicare for claims that contain certain incomplete or invalidinformation and are returned to the provider. For example, a...
View ArticleUnderstanding Multiple Carrier TPR Codes in Healthcare Billing
Multiple carrier TPR codesMP Primary insurance paid – secondary paidSU Primary insurance paid – secondary under deductibleMU Primary and secondary under deductiblePU Primary insurance under deductible...
View ArticleCritical Care Billing: Criteria for Teaching Physicians
Teaching Physician Criteria billing critical careIn order for the teaching physician to bill for critical care services the teaching physician must meet the requirements for critical care described in...
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CMS-1500 Claim Form Submission Guidelines
Specifications for Submitting CMS–1500 Claim FormsFontUsing the proper font will greatly help with alignment of data submitted on paper claims. Print must be Pica10 or 12-point typeface, and only...
View ArticleSample Authorization Form and Wording for Medicare & Medigap Benefits
Sample authorization formSAMPLE WORDING FOR AUTHORIZATIONSONE-TIME AUTHORIZATIONFor Use by ProviderBeneficiary Name____________________________HIC#___________________________I request that payment of...
View ArticleBilling for Allogeneic Stem Cell Transplants: Revenue Code 0819 Guide
Billing for Allogeneic Stem Cell Transplants - Revenue code 081. Definition of Acquisition Charges for Allogeneic Stem Cell TransplantsAcquisition charges for allogeneic stem cell transplants include,...
View ArticleKey Data Elements for EMC 837: Ensuring Medicare Claim Compliance
Must require Date elements EMC 837Required Data Element RequirementsThe following Medicare-specific, return as unprocessable requirements in this section and the following two sections are in addition...
View ArticleProvider Termination Process in Medicare Program
Effective date of provider termination Voluntary TerminationAccording to 42 CFR 489.52, a provider that wishes to terminate its agreement to participate in the Medicare program may do so by: (1)...
View ArticleUnderstanding Accept Assignment in Medicare Part B
Meaning of Accept Assignment ?1. Meaning of Assignment - For purposes of this agreement, accepting assignment of the Medicare Part B payment means requesting direct Part B payment from the Medicare...
View ArticleUnderstanding Billing for Allogeneic Stem Cell Transplants and Acquisition...
Thursday, November 24, 2016Billing for Allogeneic Stem Cell Transplants - Revenue code 08191. Definition of Acquisition Charges for Allogeneic Stem Cell TransplantsAcquisition charges for allogeneic...
View ArticleUnderstanding Receipted Bills in Healthcare Billing
Carrier Receipted Bill - DefinitionA receipted bill is a written acknowledgment by a person or organization furnishing specified covered services, which states that payment has been made for all...
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