Nov 22, 2016 | Medical billing basics
A. The conditions of these policies and procedures and the contracting provider agreement apply to all benefit programs, indemnity and to self-insured plans administered by BCBSKS or its subsidiaries, including those with deductibles, coinsurance and shared payments....
Nov 19, 2016 | Medical billing basics
A. All non-physicians, who are defined as eligible providers under the member’s BCBSKS contract and who are providing services as defined in their Kansas licensure or certification, shall bill their charges to BCBSKS under their own National Provider Identifier (NPI)...
Nov 14, 2016 | Medical billing basics
Timeframe for Claims Submission Providers must submit clean claims within 90 days of the date of services or the date of discharge for inpatient services. The 1199SEIU Benefit Funds may deny claims submitted more than one year after the date of service or discharge...
Nov 9, 2016 | Medical billing basics
Primary care practitioners are defined as: (1) A physician who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine for whom primary care services accounted for at least 60 percent of the allowed charges...
Nov 6, 2016 | Medical billing basics
Bundling of Payments for Services Provided in Wholly Owned and Wholly Operated Entities (including Physician Practices and Clinics): 3-Day Payment Window In accordance with section 102(a)(1) of the PACMBPRA, for outpatient services furnished on or after June 25,...
Nov 2, 2016 | Medical billing basics
Effective: 01-01-11 and 04-04-11, Implementation: 01-03-11 for the claim identification of the incentive and 04-04-11 for full implementation) The incentive payment applies to major surgical procedures, that are defined as 10 – and 90 – day global...
