Jan 31, 2013 | Medical billing basics
Screening Fecal-Occult Blood Tests (FOBT) (Codes G0107 & G0328) Effective for services furnished on or after January 1, 2004, one screening FOBT (code G0107 or G0328) is covered for beneficiaries who have attained age 50, at a frequency of once every 12 months...
Jan 26, 2013 | Medical billing basics
Flu Shot CPT code list • 90655-Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use; • 90656-Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years...
Jan 2, 2013 | Medical billing basics
Emergency Services Emergency services are not subject to prior authorization requirements and are available to our members 24 hours a day, seven days a week, 365 days a year. An emergency medical condition is a medical condition manifesting itself by acute symptoms of...
Dec 27, 2012 | Medical billing basics
All of the following procedures and services require Prior Plan Notification and must beprovided in a SHP participating facility o Inpatient and Observation Admissions, as noted aboveo Admission to any rehabilitation and skilled nursing facility o All surgical...
Dec 22, 2012 | Medical billing basics
For those services included on the SHP Quick Authorization Form (QAF) (see the Forms Section of this handbook) a referral is NOT required. Primary Care Physicians (PCP’s) can refer a member to a participating specialist and to many frequently requested services...
Dec 17, 2012 | Medical billing basics
Physician Use of Health Care Extenders (ARNP’s and PA’s): Physicians must, in accordance with federal and state regulations and accepted professionalstandards, use physician extenders appropriately. Advanced Registered Nurse Practitioners(ARNPs) and Physician...
