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Claims Overlap FAQs 01/28/2021
For the new A/B Rebilling process, what should be billed on the 13x type of bill (TOB) versus on the 12 TOB? 01/28/2021
How do I bill my claims when a patient revokes or elects hospice coverage during his/her inpatient stay? 01/28/2021
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. 01/28/2021
How do you bill the JW Modifier for the drug amount discarded and/or not administered to the patient if the drug has a Medically Unlikely Edit (MUE)? 01/28/2021
How should I submit Medicare claims for Radium Ra-223? 01/28/2021
How should units be billed for outpatient Bevacizumab (Avastin) services? 01/28/2021
I am a provider and need to make a claim adjustment; can I submit a Voluntary Refund Form, include a hard copy check and send it to Finance and Accounting? 01/28/2021
I am receiving reason code W7062, which means 'code not recognized by OPPS; alternative code for same service may be available', on several of our outpatient hospital claims. Where can I find coding guidance? 01/28/2021
I have a claim where all lines are rejected due to reason code 10416. What does this code mean? 01/28/2021
My claim contains HCPCS code C9399 (Unclassified drugs or biologicals), and received reason code 32512 indicating that the associated units must be equal to one. Please explain this reason code. 01/28/2021
We have a clinical pharmacist onsite that wants to talk to patients about their medications. Can the FQHC bill this service under Medicare Part A as a core visit? 01/28/2021
What conditions will contractors allow for exceptions to and extension of timely filing requirements? 01/28/2021
What is interim billing for prospective payment system hospitals? 01/28/2021
What is the correct billing for drug screens, specifically HCPCS code G0431? 01/28/2021
What is the timeframe for submitting a claim adjustment? 01/28/2021
When is it appropriate to bill 14x Type of Bill (TOB) for lab charges? 01/28/2021
Where can providers find additional information regarding the Recovery Audit Contractor (RAC) process? 01/28/2021
Where is the SNF consolidated billing list? I have researched this on the CMS website and went to the SNF consolidated billing section, but I was never able to locate an actual list that shows any codes. 01/28/2021
A Local Coverage Determination (LCD) is denoted as superseded on the CMS website. Please provide me with the advisory, notice or policy that gives the verbiage which supersedes this LCD. It is rumored that the supporting diagnosis codes have been revised, but there is no record I have found to verify this. 01/27/2021
A PIP hospital provider received a demand letter requesting payment on a RAC DRG change that resulted in an overpayment. If the provider issues a check to Palmetto GBA and the claim is also adjusted in the FISS system, will we not be repaying the amount twice, both in the check issued and then upon cost report settlement? 01/27/2021
Are hospital labs that file institutional claims exempt from the MolDx Program requirements? 01/27/2021
Can a provider bill a skilled nursing facility (SNF) or swing bed (SB) claim if the patient does not have a qualifying hospital stay? 01/27/2021
Can Medicare Secondary Payer and Tertiary Payer claims be submitted electronically? 01/27/2021
Can we use the therapy progress notes and/or the plan of care documentation without the Physician or Nurse Practitioner signature to code from for Medicare claims? 01/27/2021
How do I find out why a claim has been returned to the provider (RTP) for correction? 01/27/2021
I have a lot of claims in 'S' status with reason code 30928. Can someone explain why my claims are being held? 01/27/2021
I submitted an electronic adjustment to correct a medically denied line, why was the claim returned to the provider (RTP)? 01/27/2021
Provider Contact Center (PCC) Frequently Asked Questions (FAQ): April 1, 2020 - June 30, 2020 01/27/2021
Provider Contact Center (PCC) Frequently Asked Questions (FAQ): January 1, 2020 - March 31, 2020 01/27/2021
What is a PTAN? 01/27/2021
How is the Medicare Advantage (MA) supplemental wraparound payment made to Federally Qualified Health Centers? 12/21/2020
Provider Contact Center (PCC) Frequently Asked Questions (FAQ): July 1 - September 30, 2020 12/21/2020
After I receive a 277CA will I receive anything else? 12/15/2020
Can I share my DDE ID? 12/15/2020
How can I tell if I am set up for Electronic Billing? 12/15/2020
How do I reset my DDE password? 12/15/2020
How do I restore a remit file? 12/15/2020
If I have an existing DDE ID with another company, can I request a new ID? 12/15/2020
Is the 277CA returned for each test submission? 12/15/2020
Is the Submitter ID required on the DDE enrollment form? 12/15/2020
PC-ACE Pro32 software FAQs 12/15/2020
What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance? 12/15/2020
What is a Network Service Vendor? 12/15/2020
What is an approved software vendor? 12/15/2020
What is the difference between a Submitter ID and a DDE ID? 12/15/2020
What provider address should I include on the EDI enrollment forms? 12/15/2020
What provider name should I include on the EDI enrollment forms? 12/15/2020
What PTAN should I enter on the EDI enrollment forms if the provider is a member of a group? 12/15/2020
What Submitter Name should I enter on the Provider Authorization form? 12/15/2020
When is a provider authorization form required? 12/15/2020
Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description? 12/15/2020
Will you reject claims with a P.O. Box in the billing provider address? Will you reject claims where the group number and policy number are the same values? 12/15/2020
Do you have a coding question? 12/01/2020
How do I find Comprehensive Error Rate Testing (CERT) information in the eServices portal? 12/01/2020
How do I make text larger to make it easier to read? 12/01/2020
What does 'forwarding balance' mean on my remittance notice? 12/01/2020
Where can I find information about the new Medicare cards project? Open in New Window12/01/2020
Why do the links in my email listserv not work? 12/01/2020
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? 10/27/2020

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