Provider Rights when Fraud or abuse suspected
Provider Rights when Fraud or abuse suspected If Fraud or Abuse of Benefits Is Suspected If the Fraud and Abuse […]
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Basic billing concept
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Claims Submission Protocols And Standards
Claims Submission Protocols And Standards Prestige Health Choice will reimburse providers for the delivery of covered services as follows: 1.
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CPT FOR Neurophysiology evoked potential NEP
CPT FOR Neurophysiology evoked potential NEP CPT/HCPCS Codes Group 1 Paragraph: N/A Group 1 Codes: 92585Auditor evoke potent compre 92586Auditor
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When Beneficiary Statement is Not Required for Physician/Supplier Claim
When Beneficiary Statement is Not Required for Physician/Supplier Claim A. Enrollee Signature Requirements A request for payment signed by the
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Basic requirement for complete claim – CMS 1500
Basic requirement for complete claim – CMS 1500 Complete claims requirements • Member’s name • Member’s address • Member’s gender
Who Must Use the CMS/HCFA 1500
If you are one of the following providers, you must use the CMS/HCFA 1500 form:Advance Practice Registered Nursing ServicesAmbulancesAmbulatory Care
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Visit payment and Episode claiming
Visit payment and Episode claiming VISIT PAYMENT POLICIES AND THE TRANSITION OF EPISODE CLAIMING: A “visit” is defined as a
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Provider Reactivation Changes Effective March 18, 2015
Provider Reactivation Changes Effective March 18, 2015 Change Request 8901, implemented on March 18, 2015, incorporated several provider enrollment policies
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What is Re-credentialing, delegated credentialing and facility credentialing
What is Re-credentialing, delegated credentialing and facility credentialing Re-Credentialing All providers must be re-credentialed every three years to continue their
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Present On Admission (POA) Indicators
Present On Admission (POA) Indicators Provider Types Affected ** Hospitals who submit claims to fiscal intermediaries (FI) or Medicare Part