Claims - JF Part B

Claim Submission

• CMS-1500 Claim Form Crosswalk to EMC Loops/Segments - View commonly used CMS-1500 Claim Items and electronic counterparts
• CMS-1500 Claim Form Guidelines and Tips - Follow these claim guidelines to avoid processing delays, denials or inaccurate payments
• CMS-1500 Claim Form Instructions - View required claim form instructions and item specific tips, where necessary
• CMS-1500 Claim Form Tutorial - View image of claim form and move cursor over Items for claim form completion details
• Electronic Claim Submission - Connect with Electronic Data Interchange (EDI) about electronic claim submission
• ICD-10 Diagnosis - View diagnosis requirements, billing guides, training information and resources
• Place of Service - View two-digit numeric place of service codes used for claim completion

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 premium, deductible and coinsurance amounts
• Assignment of Benefits - Beneficiary requirements for submission of claims are separate from assignment of benefits
• Claim Submission Billing, Errors and Solutions - View common claim submission billing, errors and solutions
• 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
• Denial Code Resolution - View common claim submission error codes, descriptions of issues, and potential solutions
• Electronic Submission of Medical Documentation (esMD) - This Medicare pilot project gives some providers a new mechanism for submitting medical documentation to review contractors
• Eligibility and Entitlement for Persons with Medicare - View how different patient programs affect a beneficiary
• Mandatory Claim Submission - Providers and suppliers must submit Medicare claims for all covered services on behalf of Medicare beneficiaries
• Medically Unlikely Edits (MUEs) - Maximum number of units of service, per HCPCS/CPT, a provider can report for a beneficiary on a date of service. Not all codes have an MUE
• 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
• Medigap - Health insurance policy offered by a private entity to persons entitled to Medicare benefits and is designed to supplement Medicare benefits. It fills in some "gaps" in Medicare coverage
• Miscellaneous Services and Charges - View various miscellaneous service topics and related charges
• Modifier and HCPCS Changes - View new and deleted National Level II modifiers and HCPCS codes
• National Correct Coding Initiative (NCCI) Edits - Access code pairs that should not be reported together for a number of reasons
• Professional Provider Telecommunications Network (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 is a segment within 837 Professional and Institutional electronic transactions which provides ‘linkage' between electronic claims and additional documentation necessary for claims processing
• Railroad Medicare - When a beneficiary's Medicare card shows an alpha-prefix instead of a suffix, patient is eligible for Railroad Retirement benefits Medicare Part B. Submit claims and inquiries to Palmetto Government Benefits Administration
• Timely Filing - View timely filing requirements for claim submission