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Claim Submission Billing, Errors and Solutions

Blood and Blood Products Billing Guide - Medicare blood deductible applies only to OPPS provider purchases whole blood or packed red cells from a community blood bank or OPPS provider assesses a charge for blood collected in its own blood bank that reflects more than charges for blood processing and storage.

Diagnosis Driven MSP Claim Rejections - View the steps necessary to adjust a claim that has rejected for a diagnosis driven insurance when the claim is unrelated to the open file.

Inpatient PPS Billing for Cost Outlier Decision Tree - The IPPS Outlier tool was developed based on scenarios encountered by the Noridian Provider Contact Center

Outpatient Coding Questions - Providers may address Healthcare Common Procedure Coding System (HCPCS) related inquiries to "Central Office on HCPCS." Mail or fax

Provider Enrollment, Chain, and Ownership System (PECOS) - If you order or refer items or services for Medicare beneficiaries and you do not have a Medicare enrollment record, you must submit an enrollment application to Medicare. You can do this using Internet-based PECOS or by completing paper enrollment application (CMS-855O).

Quick Reference Billing Guide - View compilation of most commonly used coding and billing processes for Medicare Part A claims

Reason Code Guidance - View most common claim submission error codes, a description of issue and potential solutions

Returned to Provider (RTP) Help - List of common reason codes why claims are Returned to Provider (RTP) for correction

Services Provided Outside the United States - View exceptions to "foreign" exclusion


Last Updated Oct 31, 2017