List of Fields user for secondary cross over
Medicare Crossover for Other Blue Plan Members (CMS-1500)Completing a claim correctly when a member has primary coverage with Medicare and secondary coverage (Medicare Supplement) from another Blue...
View ArticleNot authorized, and should be paid by another party
3. The medical services are not covered or authorized for the provider and/or recipient.?? There are limits to the number of units that can be billed for certain services. Verify that you entered the...
View ArticleUB 04 - Fields used for cross over - primary to secondary
Medicare Crossover for Other Blue Plan Members (UB-04)Completing a claim correctly when a member from another Blue Cross and/or Blue Shield Plan has primary coverage with Medicare will decrease your...
View ArticleHOW TO FILE AN ADJUSTMENT REQUEST
If you have been paid, but paid incorrectly for a claim or received payment from a third party after Medical Assistance has made payment, you must complete and submit an Adjustment Request Form (DHMH...
View ArticleCan we QMB Medicaid patient for coins and deductible ?
Prohibition on Balance Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program Centers for Medicare & Medicaid Services (CMS) reminds all Medicare...
View ArticleFREQUENTLY ASKED QUESTIONS on provider billing
1. When can a provider bill a recipient?You can bill the recipient only under the following circumstances:• If the service provided is not covered by Medical Assistance and you have notified the...
View ArticleWays to Improve Processes Related to QMBs
Proactive steps to identify QMB individuals you serve and to communicate with State Medicaid Agencies (and Medicare Advantage plans if applicable), can promote compliance with QMB balance billing...
View ArticlePaper CMS 1500 claim changes update MVP insurance
MVP Health Care has developed this guide to help orient you to the key data fields that are changing on the new CMS-1500 Paper Claim Form that will be accepted by MVP Health Care starting 10/1/06 and...
View ArticleCritical Care Services and Other Procedures Provided on the Same Da
Critical Care Services and Other Procedures Provided on the Same Day by the Same Physician as Critical Care Codes 99291 – 99292The following services when performed on the day a physician bills for...
View ArticleRevised paper claim form CMS-1500 (version 02/12)
All paper claims are required to be submitted using the new CMS-1500 (02/12) form.The National Uniform Claim Committee (NUCC) recently revised the CMS-1500 claim form to align the paper claim form with...
View ArticleCritical care during Global surgery CPT CODE 31500
Global SurgeryCritical care services shall not be paid on the same calendar date the physician also reports a procedure code with a global surgical period unless the critical care is billed with CPT...
View ArticleDrug Billing on CMS 1500 AND UB 04 -
• Drug Billingo Providers are required to bill GHP with the applicable NDC and CPT/HCPCs codes for drugs.** Reporting NDC on a CMS-1500 claim form• Enter the NDC in the shaded sections of item 24A...
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BCBSNC CMS 1500 instruction on Signature on File and NDC number
Box 12. Have the patient or authorized person sign or indicate “SIGNATURE ON FILE” in lieu of an actual signature if you have the original signature of the patient or other authorized person on file...
View ArticleBilling continuous visit on UB 04 form - FL 6 and FL 17
Submitting Bills In Sequence for a Continuous Inpatient Stay or Course of TreatmentWhen a patient remains an inpatient of a SNF, TEFRA hospital or unit, swing-bed, or hospice beyond the end of a...
View ArticleHow to bill Value and Revenue codes in UB 04
FLs 39, 40, and 41. Value Codes and Amounts.a. Each code must be accompanied by an amount.b. All codes are two alphanumeric digits.c. Amounts may be up to ten numeric positions. (00000000.00)d. If code...
View ArticleHow to bill Observation care on UB 04 - Locator 46
General Billing• Report inpatient services with appropriate revenue and HCPCS codes• Report the number of observation hours in Field Locator 46Observation Following ERBill observation services that are...
View ArticleFiling Date - Last date is Saturday, Sunday or Holiday - what is the process
Establishing Date of Filing - Postmark Date - CarriersWhenever the last day for timely filing of a claim falls on a Saturday, Sunday, legal holiday, or other day all or part of which is a non-work-day...
View ArticleRevenue code for Emergency room, ASC and Dialysis billing on UB04
UB-04 BillingCode Description Comments036X Operating Room Rev Code CPT/HCPCS required045X Emergency Room Rev Code Use to bill all surgical procedures performed in the emergency room.049X Ambulatory...
View ArticleDefinition of Primary Care Practitioners and Primary Care Services - CPT code...
Primary care practitioner is defined as:1. A physician who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine for whom primary care...
View ArticleCMS 1450 - Field 4 - 3 digit number how to form ?
UB 04 FL 4. Type of Billa. Must not be spaces.b. Must be a valid code for billing. Valid codes are:First Digit - Type of Facility:1 - HospitalNOTE: Hospital-based multi-unit complexes may also have use...
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