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Claims & Appeals

Appeals - The five levels in the Medicare appeals process are shown below. Prior to requesting an appeal, a provider may request changes due to clerical errors or omissions through the reopenings process.

Billing Situations - Information about Back-Up Equipment, Beneficiaries Entering Medicare, Consolidated Billing, DMEPOS and Inpatient Stays, Hospice, Indian Health Services (IHS), Medicare Advantage Plan, Medicare HMO Beneficiaries Transferring to Fee-For-Service Medicare and New Capped Rental Period.

Claim Submission - View information on assignment agreements, claim form instructions, mandatory claim submission, Medigap, signature requirements, timely filing and more.

Common Electronic Data Interchange (CEDI) - The CEDI contractor, National Government Services, provides a single electronic front end solution for all DME MAC suppliers.

Medicare Secondary Payer (MSP) - Medicare Secondary Payer (MSP) is the term used to describe when another payer is responsible for paying a beneficiary's claims before Medicare pays. Noridian protects and preserves the Medicare Trust Fund by ensuring that Medicare benefits are coordinated with all other appropriate payers and Medicare pays only when and what it should pay.

Overpayments - View information on immediate offsets, voluntary refunds, Recovery Auditor overpayments, surety bonds and more.

 

Last Updated Apr 13, 2017

CPT and ADA End User License Agreement for Providers

NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.

CPT codes, descriptors and other data only are copyright 2016 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.

Last Updated Jun 08, 2016