Claims - JF Part A

Claim Submission

• Electronic Claim Submission - Connect with EDI regarding electronic claim submissions
• ICD-10 Diagnosis - View diagnosis requirements, billing guides, training information and resources
• UB-04 (CMS-1450) Form - Access the address to order this form, view related presentation and Q&As
• Unlisted Code Billing - Review what is required when submitting an unlisted code

General

• 1099 Tax Form - Details about the 1099-MISC or 1099-INT Tax Forms, how to obtain duplicates, and steps if providers disagree with gross dollar amount
• Annual Benefits - View benefit days, coinsurance, deductible amounts
• Assignment of Benefits - Beneficiary requirements for submission of claims are separate from assignment of benefits
• Claims Processing Timeliness Interest Rate - If payment is not made within 30 days (ceiling period) after date of receipt, interest must be paid on clean claims
• Claim Submission Billing, Errors and Solutions - Common Claim Submission Billing, Errors and Solutions
• Electronic Submission of Medical Documentation (esMD) - This Medicare pilot project gives some providers a new mechanism for submitting medical documentation to review contractors
• Integrated Outpatient Code Editor (IOCE) and Medicare Code Editor (MCE) - The IOCE program processes claims for all outpatient institutional providers including hospitals subject to Outpatient Prospective Payment System (OPPS) and Non-OPPS hospitals. The MCE is inpatient code editor and is used to detect claim errors based on coding included on UB-04 claims
• Medicare Advantage Inpatient Claim "Shadow Billing" - For Medicare Advantage (MA) plan beneficiaries, CMS requires providers to submit claims to both Medicare and the MA plan
• Medicare Beneficiary Identifier (MBI) - Congress requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A randomly generated MBI will replace SSN-based Health Insurance Claim Number on new Medicare cards
• Miscellaneous Services and Charges - View various miscellaneous service topics and related charges
• National Correct Coding Initiative (NCCI) Edits - Access National Correct Coding Initiative (NCCI) Edit Files, Medically Unlikely Edit (MUE) Files, Procedure-to-procedure (PTP) Edit Files and Add-on Code Edit Files
• Outpatient Coding Questions - Providers may address HCPCS related inquiries to "Central Office on HCPCS" Mail or fax
• PWK (Paperwork) - PWK is a segment within 837 Professional and Institutional electronic transactions which provides ‘linkage' between electronic claims and additional documentation necessary for claims processing
• Quick Reference Billing Guide - View commonly used coding and billing processes for Medicare Part A claims
• Reason Code Guidance - View common claim submission error codes, a description of issue and potential solutions
• Returned to Provider (RTP) Help - View common reason codes for claims to be Returned to Provider (RTP) for correction
• Timely Filing - View timely filing requirements for claim submission