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Claim Submission

Annual Benefits - Benefit days, Coinsurance, Deductible amounts

Claims Processing Timeliness Interest Rate - Interest must be paid on clean claims if payment is not made within 30 days (ceiling period) after date of receipt. Ceiling period is same for both EMC and paper claims

Claim Submission Billing, Errors and Solutions - Common Claim Submission Billing, Errors and Solutions

Crossover Claims - The Benefit Coordination & Recovery Center (BCRC) processes all claims crossovers:

Electronic Claim Submission - Connect with EDI regarding electronic claim submissions

Electronic Submission of Medical Documentation (esMD) - Medicare's Electronic Submission of Medical Documentation (esMD) pilot project gives some providers a new mechanism for submitting medical documentation to review contractors

HICN Suffixes - View definition of suffix in beneficiary Medicare numbers

ICD-10 Diagnosis - View diagnosis requirements, billing guides, training information and resources

Incarceration Claim Denials - Medicare will generally not pay for medical items and services furnished to a beneficiary who was incarcerated or in custody under a penal statute or rule at time items and services were furnished

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, such as Critical Access Hospitals (CAHs). The MCE is the inpatient code editor and is used to detect claim errors based on coding listed on UB-04 claims submitted to Medicare

Miscellaneous Services and Charges - Noridian receives a wide variety of questions regarding miscellaneous services and charges. Many of these situations do not have guidelines or instruction from Medicare outlined within the CMS Internet Only Manuals (IOMs), Medicare publications, or Noridian publications

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

New Medicare Card Project - Congress requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new randomly generated Medicare Beneficiary Identifier (MBI) will replace SSN-based Health Insurance Claim Number on new Medicare cards

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) - Whether a provider is enrolling in Medicare for the first time or needs to make changes to enrollment information, Internet-based PECOS is the most efficient process of submitting applications and keeping Medicare enrollment information up to date. View details

PWK (Paperwork) - PWK (Paperwork) is a segment within 837 Professional and Institutional electronic transactions. The PWK segment provides ‘linkage' between electronic claims and additional documentation which is needed for claims adjudication

Quick Reference Billing Guide - View a 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

Timely Filing - View how long a provider has to submit a claim based on date of service

UB-04 (CMS-1450) Form - Access the address to order this form, view related presentation and Q&As

 

Last Updated Jul 24, 2017