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Jurisdiction 11 Part A

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We sent a claim as Medicare primary and later discovered that another payer is primary to Medicare. When we adjusted the claim to make Medicare secondary with a D7 condition code, the claim was rejected because no payment is reported from the primary. What should we do?03/05/2015
What is a PTAN?03/05/2015
What is the effective date for the new occurrence code 55 used to report the date of death?03/05/2015
Is it acceptable to highlight information in the medical records when responding to a Medical Review Additional Documentation Request (ADR)?03/04/2015
Is there a 'Returned To Provider' report that is available for providers to print and review?03/04/2015
Palmetto GBA has stated that granular details will be provided when a claim is reviewed and denied by Medical Review. The nurse will notate specific details as to why the claims was denied. What page in the Fiscal Intermediary Shared System (FISS) Direct Data Entry (DDE) can providers review these details?03/04/2015
Revalidation Initiative: Frequently Asked Questions (FAQs)03/04/2015
Which Medicare Advantage plans will require Health Insurance Prospective Payment System (HIPPS) codes beginning July 1, 2013?03/04/2015
If I am uncertain as to whether Medicare or the CERT contractor can read my doctor's signature may I voluntarily submit a signature log when asked to provide documentation?01/20/2015
A Group Health Plan (GHP) has recouped a primary payment on a claim processed over a year old indicating Medicare should have been primary. Will Medicare override timely filing rules and process an adjustment claim?01/14/2015
If a patient is admitted into inpatient or skilled nursing facility care within 60 days of the benefits, does Medicare adjust claims to assign benefits sequentially for dates of service?12/29/2014
My remittance advice (RA) contained code LE - Levy. What does this mean?12/29/2014
What date is used to start the count of the 180 days for the submission of the Part B claim under the new A/B rebilling process?12/29/2014
Are bariatric procedures not related to weight loss covered by Medicare?12/23/2014
Are cardiac rehabilitation programs covered by Medicare?12/23/2014
Are Critical Access Hospital (CAH) 85X type of bills (TOBs) editing for the 2014 Hospital Outpatient Prospective Payment System (PPS) Clinical Diagnostic Laboratory Test Payment and Billing rule per MLN Matters article MM8572?12/23/2014
Are hospital labs that file institutional claims exempt from the MolDx Program requirements?12/23/2014
Can a provider request Healthcare Common Procedure Coding System (HCPCS) coding assistance from Palmetto GBA?12/23/2014
Do Federally Qualified Health Centers (FQHCs) bill the Part A on the UB04 claim form for influenza and Pneumococcal Pneumonia Vaccinations (PPV) vaccinations?12/23/2014
How do I enter three modifiers in Direct Data Entry (DDE)? There is no room to report the third modifier on Page 2 when keying a claim on DDE.12/23/2014
How do I sign up for Direct Data Entry?12/23/2014
How long does a provider have to submit medical records to the Comprehensive Error Rate Testing (CERT) Contractor for review?12/23/2014
I have a beneficiary who was part of a Medicare Advantage (MA) plan for part of their stay. How do I bill for their services?12/23/2014
If a hospital elects to report charges for recurring, non-repetitive services on a single bill, what must they report on the bill?12/23/2014
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last updated on 3/01/2015
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