Billing provider - License updating policy
License Update Policy Health care providers, who under the state plan and/or state statute are required to be licensed in West Virginia (WV) or the state in which they practice, must maintain and...
View ArticleCan we submit the claim if patient has provided the backdated card , what is...
Backdated Medicaid Cards If a member receives a backdated medical card and the provider wishes to accept it and bill Medicaid for services that occurred over a year ago, the claims must be billed...
View ArticleEffective Date of Provider Agreement in the Enrollment
Since one of the key issues is whether the facility has furnished “reasonable assurance” that the reasons for termination will not recur, the provider agreement cannot be effective before the date on...
View ArticleWould Medicare pay after provider termination
Reviewing Inpatient Bills for Services After Suspension, Termination, Expiration, or Cancellation of Provider Agreement, or After a SNF is Denied Payment for New AdmissionsA SNF may be denied payment...
View ArticleWhen Beneficiary Statement is Not Required for Physician/Supplier Claim
A. Enrollee Signature RequirementsA request for payment signed by the enrollee must be filed on or with each claim for charge basis reimbursement except as provided below. All rules apply to both...
View ArticleMedicare physician signature - important rules
Physician (Supplier) Signature RequirementThe rules below apply to both assigned and unassigned claims unless otherwise indicated.1. In a claim for services furnished by an individual physician (or...
View ArticleHow often Medicare paid for providers
Frequency of Billing for ProvidersDifferent types of providers are paid based on different payment policies depending upon the circumstance of the provider. These payment policies are described in...
View ArticleFrequency of Billing for Providers Submitting Institutional Claims with...
Repetitive Part B services furnished to a single individual by providers that bill institutional claims shall be billed monthly (or at the conclusion of treatment). The instructions in this subsection...
View ArticleMedicare incarcerated denial - all question and time frame solution
BACKGROUNDMedicare 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 the time items and services were...
View ArticleMedicare incarceration recoupment and appeal option
RECOUPMENTS Q1: Do suppliers and providers need to take any steps to be repaid for incorrect recoupments resulting from this issue? A1: Supplier claims will be reprocessed and refunds issued by the end...
View ArticleHow to report multiple NDC code - and format
NDC Billing Instructions Molina EDI Help Desk reports that claims are being rejected because more than one NDC code is being billed on one service line. Below you will find instructions on billing...
View ArticleFiling claim to Medicare after offset from Medicare advantage plan (HMO)
Retroactive Disenrollment from a Medicare Advantage plan or Program of All-inclusive Care for the Elderly (PACE) Provider OrganizationThere may be situations where a beneficiary is enrolled in an MA...
View ArticleWhat is the time limit when DOS has different from and TO date
Determining Start Date of Timely Filing Period -- Date of ServiceIn general, the start date for determining the 12 month timely filing period is the date of service or “From” date on the claim. For...
View ArticleWhat is Incomplete or Invalid Submissions
Services not submitted in accordance with CMS instructions include:• Incomplete Submissions - Any submissions missing required information (e.g., no provider name).• Invalid submissions - Any...
View ArticleHandling Incomplete or Invalid Submissions - Medicare claim tips
The following provides additional information detailing submissions that are considered incomplete or invalid.The matrix in Chapter 25 specifies whether a data element is required, not required, or...
View ArticleCan we bill patient when Medicare claim denied as timely filing?
Medicare document says yes but only limited to Deductible and coins.Determination of Untimely Filing and Resulting ActionsMedicare denies a claim for untimely filing if the receipt date applied to the...
View ArticleWhat we can do further if we receive timely filing denial
Filing Claim Where General Time Limit Has ExpiredAs a general rule, where the contractor receives a late filed claim submitted by a provider or supplier with no explanation attached as to the...
View ArticleExceptions Allowing Extension of Time Limit
Medicare regulations at 42 C.F.R. §424.44(b) allow for the following exceptions to the 1 calendar year time limit for filing fee for service claims:(1) Administrative error, if failure to meet the...
View ArticleBilling Medicare - Medicaid patient . Explanation of different Medicaid plan...
Dual Eligible BeneficiariesDual eligible beneficiaries include individuals who receive full Medicaid benefits as well as those who only receive assistance with Medicare premiums or cost sharing. They...
View ArticleLicense Update Policy - From Molina Healthcare
Health care providers, who under the state plan and/or state statute are required to be licensed in West Virginia (WV) or the state in which they practice, must maintain and ensure that a current...
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