Billing, Claims, and Appeals - JD DME
Claim Denial Rate Calculator
Calculates Target Probe and Educate (TPE) reviews, individual policy categories or overall Medicare dollar percentages
Billing, Claims, and Appeals
Appeals - View details about the five levels in the Medicare appeals 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.
Electronic Claim Submission - Common Electronic Data Interchange (CEDI) - The CEDI contractor, National Government Services, provides a single electronic front end solution for all DME MAC suppliers.
Healthcare Integrated General Ledger Accounting System (HIGLAS) - A financial accounting system will enable the Centers for Medicare & Medicaid Services (CMS) to track Medicare payments and to accurately pay claims for over 40 million Medicare beneficiaries.
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 and Recoupments - View information on immediate recoupment or offsets, voluntary refunds, Recovery Auditor overpayments, surety bonds and more.
Post COVID-19 Public Health Emergency (PHE) - View information on guidelines for post PHE
Reopening - Prior to requesting an appeal, a provider may request changes due to clerical errors or omissions through the reopenings process.
CPT, ADA, and AHA 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 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.
Copyright © 2018, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816
Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association.
