Submitting worker compensation claim electronically - what are the...
Electronic Bill Attachments(a) Required reports and/or supporting documentation to support a bill as defined in Complete Bill Section 3.0 shall be submitted in accordance with this section. Unless...
View ArticleClaim rejected as Duplicated claim - What are the possible ways to find outcome?
Q: My claim rejected, or was returned to provider, as a duplicate of another claim. Can I resubmit the claim? What steps can I take to avoid duplicate claims?A: Claim system edits are in place to...
View ArticleFlorida Blue submitting secondary claim address
Filing the Medicare Cross-Over ClaimFile the claim to your Medicare carrier for primary payment. Claim information will not be crossed over to the member’s supplement plan (the secondary payer) until...
View ArticleCoding tips for Diagnostic Imaging and Laboratory codes
Diagnostic ImagingIf the treating chiropractic provider refers the reading or interpretation of a radiology service to a radiologist, reimbursement for the professional component of that service will...
View ArticleProvider having multiple location - how to enroll
Service Locations:I have multiple service locations. How do I ensure all mail and checks go to one address?Checks will be sent to the W9 address listed in the revalidation application. If multiple...
View ArticleCoding a Facility Claim Procedure, Modifier and Diagnosis Codes - Basic steps
- A critical element in claims filing is the submission of current and accurate codes to reflect the services provided. Correct coding is essential for correct reimbursement. We have applied...
View ArticleHelpful Tips in Medical coding in hospital billing - what is special days
• Diagnosis Codes: When reporting diagnosis codes a decimal point must not be submitted as the decimal point is implied.• Single Date: Under 5010, a date range must be supplied and a single date is no...
View ArticleTimely filing limit for BBHHF providers
Timely Filing for BBHHF Providers;Timely Filing Policy under Charity Care To meet timely filing requirements for the BBHHF Charity Care program, claims must be received within 180 days from the date of...
View ArticleWHY POS is important in claim submission ?
Reporting place of service (POS) codesPhysicians are required to report the place of service (POS) on all health insurance claims they submit to Medicare Part B contractors. The POS code is used to...
View ArticleDocument accepted as proof of TFL
Filing DeadlineFiling Deadline PolicyTufts Health Plan follows the guidelines described in the Tufts Health Plan Claims Submission Policy. For professional or outpatient services, Tufts Health Plan...
View ArticleCPT CODES Q9981, Q9982 AND Q9983 WITH ZB modifier
Medicare providers and suppliers that effective for claims with dates of service on or after July 1, 2016, new Healthcare Common Procedure Coding System (HCPCS) codes Q9981 (rolapitant, oral, 1mg);...
View ArticleCPT code G9002, G9012, H2011, H2011 and S5121 with covered ICD 10 codes
HCPCS Modifier Description DiagnosisG9002 Coordinated Care Fee, Maintenance Rate (Ongoing Children’s Service Coordination) 1 Unit = 15 minutes, PA is required.G9002 HM Service Coordination...
View Articlechanges in reimbursement - Billing professional and technical component -
Modifier 26Professional Component: Certain procedures are a combination of a physician component and a technical component. When the physician component is reported separately, the service may be...
View ArticleCan we bill Attorney for Medical cost ?
SubrogationSubrogation is another liability recovery activity in which medical costs that are the result of actions or omissions of a third party are recovered from the third party (and/or his...
View ArticleHome health - Patient Eligibility criteria - Part 1
Certifying Patients for the Medicare Home Health BenefitThis MLN Matters® SE1436 article gives Medicare-enrolled providers an overview of the Medicare home health services benefit, including patient...
View ArticleHome health - Patient Eligibility criteria - Part 2 - Re-certification...
Certification Requirements: Who Can Perform a Face-to-Face EncounterAccording to 42 CFR 424.22(a)(1)(v)(A), the face-to-face encounter can be performed by:** The certifying physician;** The physician...
View ArticleDevelopment therapy CPT code list
CPT/ HCPCS Description H2011 Intervention for participant in crisis situations. (See IDAPA 16.03.10, Subsection 613.13 for specific requirements). Service is limited to a maximum of 20 hours per...
View ArticlePOS comes under Facility and non facility payment fee schedule
Site of Service Payment DifferentialUnder the Medicare Physician Fee schedule (MPFS), some procedures have separate rates for physicians’ services when provided in facility and nonfacility settings....
View ArticleWhat is Correct coding policy - For Beginners - Part 1
Correct Coding PolicyThe Correct Coding Initiative was developed to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims.The...
View ArticlePart 2 - What is Correct coding policy - For Beginners
F. Designation of SexMany procedure codes have a sex designation within their narrative. These codes are not billed with codes having an opposite sex designation because this would reflect a conflict...
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