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Claim Submission Timeliness Calculator

 



 

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Claim Submission

Annual Benefits - See premium, deductible and coinsurance amounts.

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

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

CMS-1500 Claim Form Crosswalk to EMC Loops and Segments - A list of the most comonly used CMS-1500 Claim Items and their electronic counterparts.

CMS-1500 Claim Form Instructions - Required elements of the claim form are provided.

CMS-1500 Claim Form (Version 02/12) Completion Tips - Tips for completing the newer items in Version 02/12

CMS-1500 Claim Form Tutorial - Move the cursor for more information on how to complete the claim form.

Crossover Claims - The Benefit Coordination & Recovery Center (BCRC) processes all claims crossovers. View the details: CMS Coordination of Benefits (COB) webpage, Supplemental Insurance vs. Secondary Insurance, Trading Partner/Supplemental Insurer Criteria Selections

Electronic Claim Submission - Connect with Electronic Data Interchange (EDI) regarding electronic claim submissions.

HICN Suffixes - View the definition of the suffix in beneficiary Medicare numbers.

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

Mandatory Claim Submission - When Congress passed the Omnibus Budget Reconciliation Act of 1989, it included the requirement that providers and suppliers submit Medicare claims for all covered services on behalf of Medicare beneficiaries, beginning September 1, 1990.

Medically Unlikely Edits (MUEs) - An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. All HCPCS/CPT codes do not have an MUE.

Medigap - It is a health insurance policy or other health benefit plan offered by a private entity to those persons entitled to Medicare benefits and is specifically designed to supplement Medicare benefits. It fills in some of the "gaps" in Medicare coverage by providing payment for some of the charges for which Medicare does not have responsibility due to the applicability of deductibles, coinsurance amounts, or other limitations imposed by 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.

Modifier and HCPCS Changes - View the new and deleted National Level II modifiers and HCPCS.

National Correct Coding Initiative (NCCI) Edits - Access code pairs that should not be reported together for a number of reasons.

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 the SSN-based Health Insurance Claim Number on new Medicare cards.

Place of Service - The Medicare program uses a two-digit (11 for office) numeric place of service coding structure. The place of service identifies the location where the item was used or the service was performed. A place of service is required for all services and must be entered in Item 24B of the CMS-1500 claim form or in the electronic equivalent.

Professional Provider Telecommunications Network (PPTN) - PPTN allows providers to access beneficiary eligibility, claim status, summary of claim volume and payments, pricing information and diagnosis and procedure code lookups.

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

Railroad Medicare This link will take you to an external website. - When a beneficiary's Medicare card shows an alpha-prefix instead of a suffix (A000000000), patient is eligible for Railroad Retirement benefits Medicare Part B claims or related questions for Railroad beneficiaries must be submitted to:

Palmetto Government Benefits Administration
PO Box 10066
Augusta, GA 30999

Timely Filing - The timely filing requirements for claim submission are provided.

 

Last Updated Jul 24, 2017