May 23, 2013 | Medical billing basics
“Primary Care Physician (PCP)” means a Participating Physician who supervises, coordinatesand provides primary care services to Enrollees, including the initiation of their referral for specialistservices and other non-PCP services, and who meets all the other...
May 16, 2013 | Medical billing basics
“Interdisciplinary Care Team” or “ICT” refers to interdisciplinary services provided by atreatment team in which all of its members participate in a coordinated effort to benefit the patientand the patient’s significant others and caregivers. Interdisciplinary...
May 10, 2013 | Medical billing basics
“Capitation Fee” means the monthly payment made by CarePlus to the Provider for each Enrolleeassigned to Provider. The amount of the Capitation Fee is set forth in the PCP Agreement. “Clean Claim” is a claim that has no defect or impropriety, including lack of...
May 6, 2013 | Medical billing basics
Where do I submit claims to MediPass? What is the claim address and can it be submitted electronically? I have contacted different Medicaid provider phone numbers, but I have not received any response back. Claims for recipients in MediPass are billed just...
Apr 30, 2013 | Medical billing basics
How do I document verification of recipient eligibility? You can obtain a call reference number through the AVRS. If you use the Web Portal you may choose to save a copy of the screen print or print out a hardcopy. If you use a MEVS vendor you will receive hard copy...
Apr 23, 2013 | Medical billing basics
MANAGED CARE How do we find out which network provider to call? If you check eligibility through the web portal, look for this information in the Managed Care section of the recipient’s eligibility screen. You will find the name, type and phone number of the HMO, PSN...
Apr 17, 2013 | Medical billing basics
When checking eligibility, sometimes, there is COMMERCIAL INSURANCE listed on the Medicaid website as primary payer. After checking the primary payer websites, I find that the commercial insurance has terminated – sometimes up to 8 months prior. What can I tell...
Apr 9, 2013 | Medical billing basics
Can you please let me know how to check eligibility on share of cost patients? A Medically Needy recipient is an individual who would qualify for Medicaid, except that the individual’s income or resources exceed Medicaid’s income or resource limits. A Medically...
Apr 3, 2013 | Medical billing basics
Can you clarify if Medicaid only covers Medicare part B premium? Is the patient responsible for the 20% coinsurance? If you are referring to persons who only have coverage as Special Low Income Medicare Beneficiaries (SLMB) or as Qualifying Individuals I (QI1), this...
Mar 29, 2013 | Medical billing basics
What is CPT? CPT was developed by the American Medical Association (AMA) in 1966. The AMA revises and publishes CPT each year to keep pace with changes in medical practice. They delete obsolete procedures, modify existing procedures, and add newly developed...
