Mar 6, 2016 | Medical billing basics
enrollment/revalidation process. *** For information related to the pay-to provider: *** NPI *** Tax ID on file with Molina which is provided on your case number letter —Federal Employer Identification Number (FEIN) (this may be the Social Security Number (SSN) ***...
Feb 24, 2016 | Medical billing basics
National Provider Identifier (NPI) The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the adoption of a standard unique identifier for healthcare providers. The Centers for Medicare and Medicaid Services (CMS) has assigned national...
Feb 17, 2016 | Medical billing basics
What is PEAP? PEAP is the Internet-based Provider Enrollment/Revalidation Application Portal (PEAP) that will be accessed by pay-to providers newly enrolling or revalidating with West Virginia Medicaid beginning in the Summer of 2013. What does Fiscal Agent mean?...
Feb 7, 2016 | Medical billing basics
(s) “NCPDP” means the National Council for Prescription Drug Programs. (t) Official Medical Fee Schedule (OMFS) means all of the fee schedules found in Article 5.3 of Subchapter 1 of Chapter 4.5 of Title 8, California Code of Regulations (Sections 9789.10 –...
Jan 31, 2016 | Medical billing basics
k) “Duplicate bill” means a bill that is exactly the same as a bill that has been previously submitted with no new services added, except that the duplicate bill may have a different “billing date.” (l) “Electronic Standard Formats” means the ASC X12N...
Jan 31, 2016 | Medical billing basics
Timely Filing Policy To meet timely filing requirements for WV Medicaid, claims must be received within one year from the date of service. The year is counted from the date of receipt to the “from date” on a CMS 1500, Dental or UB04. Claims that are over one year old...
Jan 23, 2016 | Medical billing basics
1.0 Standardized Billing / Electronic Billing Definitions; (a) “Assignee” means a person or entity that has purchased the right to payments for medical goods or services from the health care provider or health care facility and is authorized by law to collect payment...
Jan 22, 2016 | Medical billing basics
Errors That Result In Denied Claims; This information is presented for you to review your internal procedures and identify areas where the number of denied claims could be reduced. Denied claims result in delay of payment. Please note HIPAA claim adjustment reason and...
Jan 12, 2016 | Medical billing basics
New and revised place of service codes for outpatient hospitals Note: This article was revised December 9, 2015, to clarify the effective date of place of service (POS) 19. POS 19 will be accepted for any claims processed on or after January 1, 2016. That is, POS code...
Jan 8, 2016 | Medical billing basics
ABN modifiers When a patient is notified in advance that a service or item may be denied as not medically necessary, the provider must annotate this information on the claim (for both paper and electronic claims) by reporting modifier GA (waiver of liability statement...
