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Claims

Claim Submission

General

  • Annual Benefits - View premium, deductible and coinsurance amounts
  • Claim Submission Billing, Errors and Solutions - View common claim submission billing, errors and solutions
  • Claims Processing Timeliness Interest Rate - Interest must be paid on clean claims if payment is not made within 30 days (ceiling period) after receipt date. View more
  • Electronic Submission of Medical Documentation (esMD) - This Medicare pilot project gives some providers a new mechanism for submitting medical documentation to review contractors
  • Mandatory Claim Submission - Providers/suppliers must submit Medicare claims for all covered services on behalf of Medicare beneficiaries. View details
  • 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. View details
  • 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. View details
  • 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. View details
  • 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
     

Last Updated May 14, 2018