LTC Claims Training- Region 11 January 2014

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "LTC Claims Training- Region 11 January 2014"

Transcription

1 LTC Claims Training- Region 11 January 2014

2 Submitting Claims All Providers must submit claims in order to receive payment each month. Claims can be submitted in the following ways: On paper, using a current version CMS 1500 form Electronically, via Molina Healthcare s Web Portal Electronically, via a clearinghouse

3 Direct Deposit of Funds Providers are encouraged to enroll in Electronic Funds Transfer (EFT) in order to receive payments quicker. Molina Healthcare s EFT provider is ProviderNet. To enroll, visit:

4 LTC HCPCS Listing

5 Code Mod #1 Service Unit Reimbursement S5135 Adult Companion Services 15 minute-unit S5100 Adult Day Health Care 15 minute-unit T1020 Assisted Care Services per day T2030 Assisted Living Services per day S5125 Attendant Care Services 15 minute-unit H2019 Behavioral Management Intervention per visit H2020 Behavioral Management Assessment per visit S5110 Caregiver Training/ Support- Group 15 minute-unit Caregiver Training/ Support- Individual 15 minute-unit G9002 Case Management 15 minute-unit S5165 Home accessibility Adaptation Services per job S5170 Home Delivered Meals per meal S5130 Homemaker Services 15 minute-unit G9004 Homemaker Services- Pest Control-Initial Visit per visit G9005 Homemaker Services- Pest Control-Maintenance per month T1002 HN Intermittent and Skilled Nursing, BSN per visit T1002 Intermittent and Skilled Nursing, RN per visit T1003 Intermittent and Skilled Nursing, LPN per visit E1399 Specialized Medical Equipment and supplies per authorization E1399 AU Specialized Medical Equipment and supplies for trach supplies per authorization S5199 Medical Equipment And Supplies, Personal Care Item Regular Miscellaneous per authorization S5199 AU Medical Equipment And Supplies, Personal Care Item for Trach Miscellaneous per authorization T1502 HN Medication Administration of oral, intramuscular, and or sub medication by BSN per visit Medication Administration of oral, intramuscular, and or sub medication by per visit T1502 TD RN T1502 TE Medication Administration of oral, intramuscular, and or sub medication by LPN per visit

6 T1503 T1503 T1503 Code Mod #1 Service HN TD TE Medication Administration other than of oral, intramuscular, and or sub medication by BSN Medication Administration other than of oral, intramuscular, and or sub medication by RN Medication Administration other than of oral, intramuscular, and or sub medication by LPN H2010 HN Medication Management Comprehensive Medication Services, BSN H2010 TD Medication Management Comprehensive Medication Services, RN H2010 TE Medication Management Comprehensive Medication Services, LPN Unit Reimbursement per visit per visit per visit 15 minute-unit 15 minute-unit 15 minute-unit Nutritional Risk Reduction 15 minute-unit T1019 Personal Care 15 minute-unit S5160 Personal Emergency Response System Installation per day S5161 Personal Emergency Response System Maintenance per day S5150 Respite-In-Home 15 minute-unit T1005 Respite-Facility-Based 15 minute-unit Occupational Therapy (Enrollees over age 21) flat rate per day Physical Therapy (Enrollees over age 21) flat rate per day S5180 Respiratory Therapy Evaluation flat rate per day Respiratory Therapy Treatment Regualr (Enrollees over age 21) flat rate per day Respiratory Therapy, Treatment mechanical vent care flat rate per day Speech Therapy ( Enrollees over 21 of age) flat rate per day

7 Billing Using a CMS 1500 Form Providers must complete the following fields on the CMS-1500 in order for the claim to be processed. Field Description/Comment 1 Check the Medicaid box 1a Enter the Member s Molina Healthcare of Florida Community Plus ID Number 2 Enter the Member s Name 3 Enter the Member s Date of Birth and Sex 5 Enter the Member s Address and Telephone Number 6 Enter Self 12 Enter Signature on File 13 Enter Signature on File 21 (1) Enter the diagnosis code of a Enter the Date(s) of Service 24b Enter the Place of Service (12 Patient s Home; 13 - ALF; 99 - Other) 24d Enter appropriate CPT/HCPCS and Modifier 24e Enter the number 1 24f Enter the customary Charge for the CPT/HCPCS, Modifier for the total days or units billed on the claim line 24g Enter Days or Units of Service 25 Enter Federal Tax I.D. Number 26 Enter Member Account Number 27 Enter Yes to accept assignment 28 Enter Total Charge for all line items 30 Enter the Balance Due (same as Field 28) 31 Signature of Provider s Representative 33 Provider Billing Name, Address, Zip Code 33a Enter NPI, if applicable

8 How to Bill Long Term Care Claims To bill for long term care services, follow these steps: Identify the HCPCS code and modifier (if applicable). Determine the unit increment in the HCPCS code definition (noted on the LTC HCPCS Listing in the unit reimbursement column). Decide the billing frequency you will use for billing (daily, weekly, or monthly) Determine the total amount of units to be billed.

9 Reporting Units on Claims Case Study Jose Perez is receiving 2 hours of personal care and 3 hours of homemaker, 3 times a week, through his assigned home health agency in the month of January. To bill for these services, follow these steps: Identify the HCPCS code and modifier (if applicable). Personal Care is T1019, no modifier Homemaker is S5130, no modifier Determine the unit increment in the HCPCS code definition (noted on the LTC HCPCS Listing in the unit reimbursement column). Personal Care and Homemaker code definition requires billing in 15- minute increments. ( 15 minutes = 1 unit ; 1 hour = 4 units) Decide the billing frequency used for billing (daily, weekly, or monthly) Determine the total amount of units to be billed. LTC Service HCPC Number of hours per day # of 15 Minute Increments Total Units Daily Number of Service Days in Week Total Weekly Units Personal Care T Homemaker S

10 Correct Billed Claim

11

12 Incorrect Billed Claim

13

14 Submitting a Corrected Claim Corrected Claims can be submitted in the following way: CMS 1500 Form ( indicate on the top of the form corrected claim not a duplicate claim ). The corrected claim must be a replacement of the original claim. DO NOT submit a claim for the additional services only.

15 Sample of Corrected Claim

16

17 How to Bill Claims for Respite Care Case Study Jose Perez is receiving 8 hours of respite care, for one week, through his assigned provider in the month of January. To bill for these services, follow these steps: Identify the HCPCS code and modifier (if applicable). Respite in Facility is T1005, no modifier Determine the unit increment in the HCPCS code definition (noted on the LTC HCPCS Listing in the unit reimbursement column). Respite Care is billed in 15-minute increments. ( 15 minutes = 1 unit ; 1 hour = 4 units) The billing frequency for Respite Care is daily only. Date spans cannot be used for this service due to the contractual daily maximums associated with this service. Each Date of Service needs to be billed in an individual line of the claim.

18 Sample of Respite Claim

19

20 Questions

IlliniCare Health Plan - Quick Billing Guide

IlliniCare Health Plan - Quick Billing Guide IlliniCare Health Plan - Quick Billing Guide This guide explains how to submit a claim online using IlliniCare Health Plan s (IlliniCare) secure provider portal, as well as examples of paper claims. This

More information

LTC Monthly Claims Training How to Bill UB04 on Web Portal

LTC Monthly Claims Training How to Bill UB04 on Web Portal LTC Monthly Claims Training How to Bill UB04 on Web Portal Statewide Medicaid Managed Care: Key Components STATEWIDE MEDICAID MANAGED CARE PROGRAM MANAGED MEDICAL ASSISTANCE PROGRAM LONG-TERM CARE PROGRAM

More information

Long Term Services and Supports Billing Guidelines

Long Term Services and Supports Billing Guidelines Long Term Services and Supports Billing Guidelines The State of Illinois has altered its approach to providing Medicaid funding to members who require long term care services. Instead of providing care

More information

CMS 1500 Training 101

CMS 1500 Training 101 CMS 1500 Training 101 HP Enterprise Services Learning Objective Welcome, this training presentation will educate you on how to complete a CMS 1500 claim form; this includes a detailed explanation of all

More information

Submit Social Services Medical Or Shared Services Claim

Submit Social Services Medical Or Shared Services Claim Submit Social Services Medical Or Shared Services Claim This lesson provides instructions for creating and submitting a Social Service Medical claim in ProviderOne. Note: The Social Services Medical/Shared

More information

Level of Care Tip Sheet MANAGING CONTINUOUS HOME CARE FOR SYMPTOM MANAGEMENT TIPS FOR PROVIDERS WHAT IS CONTINUOUS HOME CARE?

Level of Care Tip Sheet MANAGING CONTINUOUS HOME CARE FOR SYMPTOM MANAGEMENT TIPS FOR PROVIDERS WHAT IS CONTINUOUS HOME CARE? Level of Care Tip Sheet National Hospice and Palliative Care Organization www.nhpco.org/regulatory MANAGING CONTINUOUS HOME CARE FOR SYMPTOM MANAGEMENT WHAT IS CONTINUOUS HOME CARE? TIPS FOR PROVIDERS

More information

Preferred Home Health Manual. January 2011

Preferred Home Health Manual. January 2011 Preferred Home Health Manual Table of Contents Home Health Benefits...3. Introduction...3. Filing a Home Health Claim...3. Conditions of Coverage for All Contracts...3. Reimbursement...3. Contract Exclusions...3.

More information

Lessons Learned from the Miami-Dade Home Health Pilots. A Training for Home Health Visits Providers in Miami-Dade December 2010

Lessons Learned from the Miami-Dade Home Health Pilots. A Training for Home Health Visits Providers in Miami-Dade December 2010 Lessons Learned from the Miami-Dade Home Health Pilots A Training for Home Health Visits Providers in Miami-Dade December 2010 Questions? Any questions that arise during the training may be emailed to:

More information

CARE PLAN OVERSIGHT POLICY

CARE PLAN OVERSIGHT POLICY REIMBURSEMENT POLICY CARE PLAN OVERSIGHT POLICY Policy Number: ADMINISTRATIVE 7.0 T0 Effective Date: July, 20 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT

More information

Claim Form Billing Instructions CMS 1500 Claim Form

Claim Form Billing Instructions CMS 1500 Claim Form Claim Form Billing Instructions CMS 1500 Claim Form Item Required Field? Description and Instructions. number 1 Optional Indicate the type of health insurance for which the claim is being submitted. 1a

More information

PROVIDER POLICIES & PROCEDURES

PROVIDER POLICIES & PROCEDURES PROVIDER POLICIES & PROCEDURES HOMEMAKER-HOME HEALTH AIDE MEDICATION ADMINISTRATION SERVICES The purpose of this policy is to provide guidance to providers enrolled in the Connecticut Medical Assistance

More information

Overview of the Florida Medicaid Therapy Services Coverage and Limitations Handbook

Overview of the Florida Medicaid Therapy Services Coverage and Limitations Handbook Overview of the Florida Medicaid Therapy Services Coverage and Limitations Handbook 2 Introduction Medicaid reimburses for physical therapy (PT), occupational therapy (OT), respiratory therapy (RT), and

More information

1500 Claims Processing Manual DHMP Health Insurance Claim Form CMS-1500

1500 Claims Processing Manual DHMP Health Insurance Claim Form CMS-1500 DENVER HEALTH MEDICAL PLAN, INC. 1500 Claims Processing Manual DHMP Health Insurance Claim Form CMS-1500 Box 1 Medicare, Medicaid, Group Health Plan or other insurance Information Show the type of health

More information

Tips for Completing the CMS-1500 Claim Form

Tips for Completing the CMS-1500 Claim Form Tips for Completing the CMS-1500 Claim Form Member Information (s 1-13) 1 Coverage Optional Show the type of health insurance coverage applicable to this claim by checking the appropriate box (e.g., if

More information

CMS 1500 (02/12) CLAIM FORM INSTRUCTIONS

CMS 1500 (02/12) CLAIM FORM INSTRUCTIONS CMS 1500 (02/12) CLAIM FORM INSTRUCTIONS FIELD NUMBER FIELD NAME 1 a INSURED S ID NUMBER INSTRUCTIONS Enter the patient s nine digit Medicaid identification number (SSN) 2 PATIENT S NAME Enter the recipient

More information

CLAIMS AND BILLING INSTRUCTIONAL MANUAL

CLAIMS AND BILLING INSTRUCTIONAL MANUAL CLAIMS AND BILLING INSTRUCTIONAL MANUAL 2007 TABLE OF ONTENTS Paper Claims and Block Grant Submission Requirements... 3 State Requirements for Claims Turnaround Time... 12 Claims Appeal Process... 13 Third

More information

UB04 INSTRUCTIONS Home Health

UB04 INSTRUCTIONS Home Health UB04 INSTRUCTIONS Home Health 1 Provider Name, Address, Telephone 2 Pay to Name/Address/ID Required. Enter the name and address of the facility Situational. Enter the name, address, and Louisiana Medicaid

More information

Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy

Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy Policy Number 2015R0121C Physical Medicine & Rehabilitation: Procedure Reduction Policy Annual Approval Date 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT

More information

99-04 - 06 Attachment A

99-04 - 06 Attachment A 99-04 - 06 Attachment A Description Definition 92507 Speech and Language Therapy - 92507 Treatment of Speech, language, voice, communication and/or auditory processing disorder (Includes aural 97532 Cognitive

More information

1. Coverage Indicator Enter an "X" in the appropriate box.

1. Coverage Indicator Enter an X in the appropriate box. CMS 1500 Claim Form FIELD NAME INSTRUCTIONS 1. Coverage Indicator Enter an "X" in the appropriate box. 1a. Insured's ID Number Enter the patient's nine-digit Medical Assistance identification number (SSN).

More information

Molina Dual Options MyCare Ohio Medicare-Medicaid Plan FAQ s

Molina Dual Options MyCare Ohio Medicare-Medicaid Plan FAQ s Molina Dual Options MyCare Ohio Medicare-Medicaid Plan FAQ s Coverage and Benefits Q: What is the Molina Dual Options MyCare Ohio Medicare-Medicaid Plan? A: Molina Dual Options is a health plan that contracts

More information

professional billing module

professional billing module professional billing module Professional CMS-1500 Billing Module Coding Requirements...2 Evaluation and Management Services...2 Diagnosis...2 Procedures...2 Basic Rules...3 Before You Begin...3 Modifiers...3

More information

Chapter 5. Billing on the CMS 1500 Claim Form

Chapter 5. Billing on the CMS 1500 Claim Form Chapter 5 Billing on the CMS 1500 Claim Form This Page Intentionally Left Blank Fee-For-Service Provider Manual April 2012 Billing on the UB-04 Claim Form Chapter: 5 Page: 5-2 INTRODUCTION The CMS 1500

More information

Nursing Facility Mechanical Ventilation Services

Nursing Facility Mechanical Ventilation Services Nursing Facility Mechanical Ventilation Services Purpose Requests for authorization of mechanical ventilation services provided in a nursing facility are submitted via the Georgia Web Portal utilizing

More information

How Are Florida s Different Home Care Providers Regulated?

How Are Florida s Different Home Care Providers Regulated? PROVIDER 1. What services can be legally provided? ¹ ² Home health aide nursing assistant (CNA) (te: Some home health agencies only provide the above services) Nursing (LPN, RN) Therapy: Physical, Speech,

More information

Home Health, Hospice and Long-Term Care. HP Provider Relations/October 2015

Home Health, Hospice and Long-Term Care. HP Provider Relations/October 2015 Home Health, Hospice and Long-Term Care HP Provider Relations/October 2015 Agenda Claim inquiry on Web interchange By member number and date of service Understand claim status information, disposition,

More information

Home Health Services Billing Manual

Home Health Services Billing Manual Home Health Services Billing Manual F245-424-000 (07-2015) Home Health Services Billing Instructions About Billing Instructions... 1 Where can you find help with L&I billing procedures?... 1 About Labor

More information

SCAN Member Eligibility & Benefits

SCAN Member Eligibility & Benefits SCAN Member Eligibility & Benefits Interactive Voice Response (IVR) Available 24 hours a day, 7 days a week Toll free number is 877-270-SCAN (7226) Online Eligibility Verification For initial setup, contact

More information

Instructions for Completing the CMS 1500 Claim Form

Instructions for Completing the CMS 1500 Claim Form Instructions for Completing the CMS 1500 Claim Form The Center of Medicaid and Medicare Services (CMS) form 1500 must be used to bill SFHP for medical services. The form is used by Physicians and Allied

More information

CSHCN Services Program Prior Authorization Request for Inpatient Rehabilitation Admission Form and Instructions

CSHCN Services Program Prior Authorization Request for Inpatient Rehabilitation Admission Form and Instructions CSHCN Services Program Prior Authorization Request for Inpatient Rehabilitation Admission Form and Instructions General Information Ensure the most recent version of the Prior Authorization Request for

More information

Welcome to the Agency for Health Care Administration Training Presentation for Potential Managed Medical Assistance Providers.

Welcome to the Agency for Health Care Administration Training Presentation for Potential Managed Medical Assistance Providers. Welcome to the Agency for Health Care Administration Training Presentation for Potential Managed Medical Assistance Providers. The presentation will begin momentarily. Please dial in to hear audio: 1-888-670-3525

More information

GUIDE TO BILLING CMS-1500 FORM (02/2012) PCS/MLTC CLAIMS

GUIDE TO BILLING CMS-1500 FORM (02/2012) PCS/MLTC CLAIMS GUIDE TO BILLING CMS-1500 FORM (02/2012) PCS/MLTC CLAIMS GUIDE TO BILLING PCS/MLTC Claims CMS 1500 Form (02-12)...1 CMS 1500 FORM FIELDS 1 through 24E Description and Use...2 CMS 1500 FORM FIELDS 24F

More information

NEW YORK STATE MEDICAID PROGRAM PRIVATE DUTY NURSING MANUAL

NEW YORK STATE MEDICAID PROGRAM PRIVATE DUTY NURSING MANUAL NEW YORK STATE MEDICAID PROGRAM PRIVATE DUTY NURSING MANUAL POLICY GUIDELINES Table of Contents SECTION I - REQUIREMENTS FOR PARTICIPATION IN MEDICAID... 2 WRITTEN ORDER REQUIRED... 2 RECORD KEEPING REQUIREMENTS...

More information

FAILURE TO PROVIDE VALID INFORMATION MATCHING THE INSURED S ID CARD COULD RESULT IN A REJECTION OF YOUR CLAIM.

FAILURE TO PROVIDE VALID INFORMATION MATCHING THE INSURED S ID CARD COULD RESULT IN A REJECTION OF YOUR CLAIM. FAILURE TO PROVIDE VALID INFORMATION MATCHING THE INSURED S ID CARD COULD RESULT IN A REJECTION OF YOUR CLAIM. Enter in the white, open carrier area the name and address of the payer to whom this claim

More information

Geographical Non-Geographical Monroe County. Agency Rates. Solo Rates. Agency Rates. Solo Rates

Geographical Non-Geographical Monroe County. Agency Rates. Solo Rates. Agency Rates. Solo Rates Rate Cost negotiated by provider per procedure 1 Adult Dental D0160UC None 10 - - 10 / Maximum Allowable Cost is $493.49 2 Behavior Analysis - Level 1 H2019UCHP 3 Behavior Analysis - Level 2 H2019UCHO

More information

Reimbursement and Claims Submission Changes for Nursing Home Provided Non-emergency Transportation for Nursing Home Residents

Reimbursement and Claims Submission Changes for Nursing Home Provided Non-emergency Transportation for Nursing Home Residents Update February 2010 No. 2010-05 Affected Programs: BadgerCare Plus Standard Plan, BadgerCare Plus Benchmark Plan, Medicaid To: Nursing Homes, HMOs and Other Managed Care Programs Reimbursement and Claims

More information

IN HOME CARE. What s available? Who pays for it?

IN HOME CARE. What s available? Who pays for it? IN HOME CARE What s available? Who pays for it? 1602 E. Ft. Lowell Road Tucson, AZ 85719 520.327.6351 email: care@catalinainhome.com www.catalina-in-home.com 1 MEDICARE HOME HEALTH Individuals are eligible

More information

Managed Care Enrollment Expansion

Managed Care Enrollment Expansion www.horizonnjhealth.com Managed Care Enrollment Expansion George Ingram Director of Contracting and Strategy Phase I ABD and DYFS with Medicaid only 40,000 People Plan self selection ending July 18 with

More information

PROVIDER CLAIMS MANUAL

PROVIDER CLAIMS MANUAL PROVIDER CLAIMS MANUAL Revised August 2015 333 South Wabash Avenue, Suite 2900 Chicago, IL 60604 312-705-2900 866-606-3700 Dear Meridian Health Plan Provider, Meridian Health Plan would like to welcome

More information

Colorado Choice Transitions (CCT) Program Reference Manual

Colorado Choice Transitions (CCT) Program Reference Manual Colorado Choice Transitions (CCT) Program Reference Manual COLORADO CHOICE TRANSITIONS PROGRAM (CCT)... 1 PROGRAM OVERVIEW... 1 POLICY GUIDANCE FOR SERVICES... 1 PROVIDER PARTICIPATION... 2 PRIOR AUTHORIZATION

More information

Physician Assessment for TEFRA. 2. Parent/guardian/designated representative contact information.

Physician Assessment for TEFRA. 2. Parent/guardian/designated representative contact information. *08OA001E-001* OKLAHOMA DEPARTMENT OF HUMAN SERVICES Tax Equity and Financial Responsibility Act (TEFRA) Home Care Program 1. Child information. Last name First name MI Gender M Date of birth Social Security

More information

Institutional Claim Billing Reimbursement. HP Provider Relations/October 2013

Institutional Claim Billing Reimbursement. HP Provider Relations/October 2013 Institutional Claim Billing Reimbursement HP Provider Relations/October 2013 Agenda Objectives Institutional Claim Basics Inpatient Claim Payment Outpatient Claim Payment Enhanced Code Auditing Billing

More information

HOME HEALTH CARE AGENCY

HOME HEALTH CARE AGENCY HOME HEALTH CARE AGENCY NHP reimburses contracted Home Health Care agencies for home health care service provided to a member with an approved home health care plan. Prerequisites Authorization, Notification

More information

Residential Care Facility Agreement

Residential Care Facility Agreement The owner and Chaplain of Treasure Valley Hospice, Clark E. Limb, has graciously agreed to make the contract his team developed for working with RALFs available to the RALF industry to use as a reference

More information

Medicare Claims Processing Manual

Medicare Claims Processing Manual Medicare Claims Processing Manual Chapter 11 - Processing Hospice Claims Transmittals for Chapter 11 Crosswalk to Source Material 10 - Overview Table of Contents (Rev. 1673, 01-30-09) (Rev. 1708, 04-03-09)

More information

NEW YORK STATE MEDICAID PROGRAM PRIVATE DUTY NURSING MANUAL PRIOR APPROVAL GUIDELINES

NEW YORK STATE MEDICAID PROGRAM PRIVATE DUTY NURSING MANUAL PRIOR APPROVAL GUIDELINES NEW YORK STATE MEDICAID PROGRAM PRIVATE DUTY NURSING MANUAL PRIOR APPROVAL GUIDELINES TABLE OF CONTENTS Section I - Purpose Statement... 2 Section II - Instructions for Obtaining Prior Approval... 3 Prior

More information

MyCare Ohio Skilled Nursing Facility Orientation

MyCare Ohio Skilled Nursing Facility Orientation MyCare Ohio Skilled Nursing Facility Orientation Demonstration/Pilot Area Demonstration/Pilot Area 2 Health Plan Options Northwest Southwest West Central Central East Central Northeast Central Northeast

More information

RI MEDICAID PROVIDER MANUAL WAIVER SERVICES

RI MEDICAID PROVIDER MANUAL WAIVER SERVICES RI MEDICAID PROVIDER MANUAL WAIVER SERVICES Version 1.3 Revision History Version Date Sections Revised Reason for Revisions 1.0 November, 2013 All sections New manual format 1.1 March, 2014 Remove CMS

More information

New York. UnitedHealthcare Community Plan Claims System Migration Provider Quick Reference Guide. Complete Claims. Our Claims Process

New York. UnitedHealthcare Community Plan Claims System Migration Provider Quick Reference Guide. Complete Claims. Our Claims Process Our Claims Process Here are a few steps to ensure you receive prompt payment: 1 Review and copy both sides of the member s ID card. members receive an ID card containing information that helps you process

More information

Administrative Code. Title 23: Medicaid Part 205 Hospice Services

Administrative Code. Title 23: Medicaid Part 205 Hospice Services Title 23: Medicaid Administrative Code Title 23: Medicaid Part 205 Hospice Services Table of Contents Table of Contents Title 23: Division of Medicaid... 1 Part 205: Hospice Services... 1 Part 205 Chapter

More information

OSCAR Health Insurance Frequently Asked Questions/General Information

OSCAR Health Insurance Frequently Asked Questions/General Information Q: What is the relationship between Oscar and ValueOptions? A. ValueOptions administers the mental health and substance abuse benefits for Oscar Health Insurance. They have contracted with ValueOptions,

More information

New Mexico Home- and Community-Based Services Waiver Provider Rate Study

New Mexico Home- and Community-Based Services Waiver Provider Rate Study New Mexico Home- and Community-Based Services Waiver Provider Rate Study December 1, 2005 Prepared for the New Mexico Human Services Department New Mexico Home- and Community-Based Services Waiver Provider

More information

ebilling Support ebilling Support webinar: ebilling terms Lifecycle of a claim

ebilling Support ebilling Support webinar: ebilling terms Lifecycle of a claim ebilling Support ebilling Support webinar: ebilling terms ebilling enrollment Lifecycle of a claim 2 Terms EDI Electronic Data Interchange Flow of electronic information, specifically claims information

More information

Medicare Supplement Coverage Options

Medicare Supplement Coverage Options Medicare Supplement Coverage Options Thank you for your interest in our Medicare Supplemental coverage options, also known as Traditional Blue (Medigap) policies. The Medicare Supplement Plans, when combined

More information

To submit electronic claims, use the HIPAA 837 Institutional transaction

To submit electronic claims, use the HIPAA 837 Institutional transaction 3.1 Claim Billing 3.1.1 Which Claim Form to Use Claims that do not require attachments may be billed electronically using Provider Electronic Solutions (PES) software (provided by Electronic Data Systems

More information

Guidelines for Completing the Residential Claim Form

Guidelines for Completing the Residential Claim Form Guidelines for Completing the Residential Claim Form 1. Bill only residential services (Room and Board, Care and Supervision, and Bed Holds) on the Residential Claim Form. All other services (including

More information

ARIZONA FOUNDATION FOR MEDICAL CARE ANSI X12 837 V.5010 COMPANION GUIDE. 1 Arizona Foundation for Medical Care

ARIZONA FOUNDATION FOR MEDICAL CARE ANSI X12 837 V.5010 COMPANION GUIDE. 1 Arizona Foundation for Medical Care ARIZONA FOUNDATION FOR MEDICAL CARE ANSI X12 837 V.5010 COMPANION GUIDE 1 Arizona Foundation for Medical Care TABLE OF CONTENTS EDI Communication...3 Getting Started...3 Testing...4 Communications...4

More information

REIMBURSEMENT POLICY CMS-1500 Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy 2/13/2013

REIMBURSEMENT POLICY CMS-1500 Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy 2/13/2013 Policy Number REIMBURSEMENT POLICY CMS-1500 Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy 2013R0121C Annual Approval Date 2/13/2013 Approved By National Reimbursement

More information

HCFA-1500 Form Completion. For the RLISYS NSF Electronic Claims Software. 2 Patient Name Patient s name as Last Name, First Name (Example: Doe, John)

HCFA-1500 Form Completion. For the RLISYS NSF Electronic Claims Software. 2 Patient Name Patient s name as Last Name, First Name (Example: Doe, John) 1 HCFA-1500 Form Completion For the RLISYS NSF Electronic Claims Software 2 Patient Name Patient s name as Last Name, First Name (Example: Doe, John) Do not include a prefix, suffix, or middle initial

More information

Billing Manual for In-State Long Term Care Nursing Facilities

Billing Manual for In-State Long Term Care Nursing Facilities Billing Manual for In-State Long Term Care Nursing Facilities Medical Services North Dakota Department of Human Services 600 E Boulevard Ave, Dept 325 Bismarck, ND 58505 September 2003 INTRODUCTION The

More information

PROTOCOLS FOR OCCUPATIONAL THERAPY PROVIDERS

PROTOCOLS FOR OCCUPATIONAL THERAPY PROVIDERS PROTOCOLS FOR OCCUPATIONAL THERAPY PROVIDERS Type of Services Provided Services provided by Occupational Therapy providers are covered for Santa Barbara Health Initiative (SBHI), San Luis Obispo Health

More information

Claim Features Training

Claim Features Training Claim Features Training Molina Healthcare s Web Portal The Web Portal is secure and available 24 hours a day, seven days a week. Register for access to our Web Portal for selfservices, including: Submit

More information

Illustration 1-1. Revised CMS-1500 Claim Form (front)

Illustration 1-1. Revised CMS-1500 Claim Form (front) Florida Medicaid Provider Reimbursement Handbook, CMS-1500 Illustration 1-1. Revised CMS-1500 Claim Form (front) Incorporated by reference in 59G-4.001, F.A.C. July 2008 1-11 Florida Medicaid Provider

More information

Billing App Update: Version 2.012

Billing App Update: Version 2.012 Billing App Update: Presented by M. Aaron Little, CPA BKD, LLP Springfield, MO mlittle@bkd.com Today s Agenda 2012 prospective payment system (PPS) rates Timely filing Healthcare Common Procedure Coding

More information

Qualis Health. Quarterly

Qualis Health. Quarterly Qualis Health Quarterly Nebraska Medicaid September 2011 Welcome to Qualis Health s quarterly newsletter for Nebraska Medicaid Services. We hope you will find the newsletter useful and informative, and

More information

Title XIX, Title XXI and Safety Net. Utilization Management Provider Handbook

Title XIX, Title XXI and Safety Net. Utilization Management Provider Handbook Children s Medical Services Network Title XIX, Title XXI and Safety Net Utilization Management Provider Handbook Thank you for participating as a Children s Medical Services Network (CMSN) provider. This

More information

INSTRUCTION FOR FORM PCF03: REQUEST FOR REHAB EXTENSION. NOTE: Fields 1 5 MUST be filled in and you must attach a completed P.C. F01.

INSTRUCTION FOR FORM PCF03: REQUEST FOR REHAB EXTENSION. NOTE: Fields 1 5 MUST be filled in and you must attach a completed P.C. F01. INSTRUCTION FOR FORM PCF03: REQUEST FOR REHAB EXTENSION NOTE: Fields 5 MUST be filled in and you must attach a completed P.C. F0. Any incomplete form WILL BE REJECTED. Enter the assigned Pre-Certification

More information

Chapter. CPT only copyright 2010 American Medical Association. All rights reserved. 20Home Health Services

Chapter. CPT only copyright 2010 American Medical Association. All rights reserved. 20Home Health Services 20Home Health Services Chapter 20 20.1 Enrollment..................................................................... 20-2 20.2 Benefits, Limitations, and Authorization Requirements...........................

More information

Department of Human Services

Department of Human Services Department of Human Services Long-Term Care Community Nursing Rule Information and Required Forms Aging and People with Disabilities and Medical Assistance Programs Topics Agency Information Oregon Health

More information

Medicaid Service Funding Options for Affordable Assisted Living in Michigan An Information Brief for Housing Professionals

Medicaid Service Funding Options for Affordable Assisted Living in Michigan An Information Brief for Housing Professionals Medicaid Service Funding Options for Affordable Assisted Living in Michigan An Information Brief for Housing Professionals 1 Table of Contents Medicaid Brief: Page: Introduction 3 Statement of the Problem

More information

Chapter 8 Billing on the CMS 1500 Claim Form

Chapter 8 Billing on the CMS 1500 Claim Form 8 Billing on the CMS 1500 Claim form INTRODUCTION The CMS 1500 claim form is used to bill for non-facility services, including professional services, freestanding surgery centers, transportation, durable

More information

Guidelines for Completing the General Services Claim Form

Guidelines for Completing the General Services Claim Form Guidelines for Completing the General Services Claim Form 1. Bill only non-residential services on the General Services Claim Form. Residential services such as room & board or care & supervision must

More information

REV. JULY 1, 2008 NEBRASKA DEPARTMENT OF NMAP SERVICES MANUAL LETTER # 51-2008 HEALTH AND HUMAN SERVICES 471 NAC 17-000

REV. JULY 1, 2008 NEBRASKA DEPARTMENT OF NMAP SERVICES MANUAL LETTER # 51-2008 HEALTH AND HUMAN SERVICES 471 NAC 17-000 MANUAL LETTER # 51-2008 HEALTH AND HUMAN SERVICES 471 NAC 17-000 CHAPTER 17-000 PHYSICAL THERAPY SERVICES 17-001 Standards for Participation: To participate in the Nebraska Medical Assistance Program (NMAP),

More information

Dental Sleep Medicine

Dental Sleep Medicine Dental Sleep Medicine The Patient and Physician Friendly Practice Insurance from A to Pay Dental Sleep Medicine A = Assignment of Benefits A procedure whereby a patient authorizes the administrator of

More information

410-127-0020 Definitions... 1. 410-127-0040 Coverage... 5. 410-127-0050 Client Copayments... 6. 410-127-0060 Reimbursement and Limitations...

410-127-0020 Definitions... 1. 410-127-0040 Coverage... 5. 410-127-0050 Client Copayments... 6. 410-127-0060 Reimbursement and Limitations... Home Health Services Administrative Rulebook Division of Medical Assistance Programs Policy and Planning Section Table of Contents Chapter 410, Division 127 Effective January 1, 2014 410-127-0020 Definitions...

More information

Care Wisconsin ICD-10 FAQs

Care Wisconsin ICD-10 FAQs Care Wisconsin ICD-10 FAQs 1. What are the improvements to ICD-10-CM/PCS coding? Answer: The new classification system provides significant improvements greater detailed information and the ability to

More information

Understanding Your Role in Maximizing Revenue in a FQHC

Understanding Your Role in Maximizing Revenue in a FQHC Understanding Your Role in Maximizing Revenue in a FQHC Cynthia M Patterson President N Charleston SC 29420-1093 Firstchoice.practicesolutions@gmail.com P: (843) 597-8437 F: (888) 697-8923 Have systems

More information

FINANCIAL REPORT FOR STATE OPERATED NURSING FACILITIES

FINANCIAL REPORT FOR STATE OPERATED NURSING FACILITIES TO BE USED UNDER PROVISIONS OF 405 IAC 1-17 FOR ALL STATE OPERATED THAT ARE CERTIFIED AS MEDICAID PROVIDERS BY THE STATE OF INDIANA OFFICE OF MEDICAID POLICY AND PLANNING. Round all dollar amounts, except

More information

Physical Medicine and Rehabilitation

Physical Medicine and Rehabilitation Physical Medicine and Rehabilitation Chapter.1 Enrollment..................................................................... -2.2 Benefits, Limitations, and Authorization Requirements...........................

More information

Medicaid Coverage & Prior Authorization for Applied Behavior Analysis Services

Medicaid Coverage & Prior Authorization for Applied Behavior Analysis Services Medicaid Coverage & Prior Authorization for Applied Behavior Analysis Services Bureau of Medicaid Services October 2012 Developed by: Yolanda Sacipa 1 Learning Objectives Provide guidance about Florida

More information

Office of Health Insurance Programs. Division of Long Term Care. MLTC Policy 13.07: Private Duty Nursing Summary. Date of Issuance: March 13, 2013

Office of Health Insurance Programs. Division of Long Term Care. MLTC Policy 13.07: Private Duty Nursing Summary. Date of Issuance: March 13, 2013 Office of Health Insurance Programs Division of Long Term Care MLTC Policy 13.07: Private Duty Nursing Summary Date of Issuance: March 13, 2013 This information is being provided as background on Fee For

More information

oppaga Florida s Medicaid Home and Community-Based Services Waivers

oppaga Florida s Medicaid Home and Community-Based Services Waivers oppaga Florida s Medicaid Home and Community-Based Services Waivers JULY 009 Report No. 09- Office of Program Policy Analysis & Government Accountability an office of the Florida Legislature Florida s

More information

Medicare Claims Processing Manual Chapter 11 - Processing Hospice Claims

Medicare Claims Processing Manual Chapter 11 - Processing Hospice Claims Medicare Claims Processing Manual Chapter 11 - Processing Hospice Claims Transmittals for Chapter 11 Table of Contents (Rev. 3118, 11-06-14) 10 - Overview 10.1 - Hospice Pre-Election Evaluation and Counseling

More information

Most Frequently Asked Questions about Applied Behavior Analysis Services for the Treatment of Children under 21 with Autism Spectrum Disorders

Most Frequently Asked Questions about Applied Behavior Analysis Services for the Treatment of Children under 21 with Autism Spectrum Disorders Most Frequently Asked Questions about Applied Behavior Analysis Services for the Treatment of Children under 21 with Autism Spectrum Disorders Common Abbreviations ABA Applied Behavior Analysis AHCA The

More information

Current State of Home Health Care. Robert J. Rosati, PhD IOM Workshop on the Future of Home Health September 30, 2014

Current State of Home Health Care. Robert J. Rosati, PhD IOM Workshop on the Future of Home Health September 30, 2014 Current State of Home Health Care Robert J. Rosati, PhD IOM Workshop on the Future of Home Health September 30, 2014 Overview Medicare Home Health Care Eligibility Services Size and Expenditures Traditional

More information

EXTENDED HOURS HOME CARE SKILLED (PRIVATE DUTY) NURSING

EXTENDED HOURS HOME CARE SKILLED (PRIVATE DUTY) NURSING Status Active Medical and Behavioral Health Policy Section: Skilled Services Policy Number: IX-01 Effective Date: 04/23/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members

More information

Completing and Submitting the Paper Member Claim Form for Student Blue Members

Completing and Submitting the Paper Member Claim Form for Student Blue Members Introduction Most of the time, a student s provider will submit claims on behalf of the member for services rendered by that provider. Sometimes, though, it may be necessary for a student to complete a

More information

Speech Therapy Outpatient Fee-For- Service Billing and Policy Manual

Speech Therapy Outpatient Fee-For- Service Billing and Policy Manual Speech Therapy Outpatient Fee-For- Service Billing and Policy Manual Provider Qualifications... 2 Eligible Providers... 2 Provider Participation... 2 General Policies... 2 Payment for Covered Services...

More information

HOSPICE SERVICES. This document is subject to change. Please check our web site for updates.

HOSPICE SERVICES. This document is subject to change. Please check our web site for updates. HOSPICE SERVICES This document is subject to change. Please check our web site for updates. This provider manual outlines policy and claims submission guidelines for claims submitted to the North Dakota

More information

How to Bill for a School-Based Clinic

How to Bill for a School-Based Clinic How to Bill for a School-Based Clinic MDwise.org MDwise is a Hoosier Healthwise/HIP Plan A Hoosier Healthwise/HIP Plan Table of Contents Introduction... 3 The Importance of School-Based Clinics... 3 Covered

More information

Home and Community Based Services Billing Manual

Home and Community Based Services Billing Manual Home and Community Based Services Billing Manual Children s Home and Community Based Services (CHCBS), Children with Life Limiting Illness (CLLI) Children with Autism (CWA) Home and Community Based Services

More information

UB-04 Claim Form Instructions

UB-04 Claim Form Instructions UB-04 Claim Form Instructions FORM LOCATOR NAME 1. Billing Provider Name & Address INSTRUCTIONS Enter the name and address of the hospital/facility submitting the claim. 2. Pay to Address Pay to address

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: private_duty_nursing_services 11/3/2005 2/2016 2/2017 2/2016 Description of Procedure or Service Private

More information

CLAIM FORM REQUIREMENTS

CLAIM FORM REQUIREMENTS CLAIM FORM REQUIREMENTS When billing for services, please pay attention to the following points: Submit claims on a current CMS 1500 or UB04 form. Please include the following information: 1. Patient s

More information

THE CASEY SCHOLARS PROGRAM

THE CASEY SCHOLARS PROGRAM Thank you for your interest in Suburban Hospital s educational opportunities. We currently offer two scholarship programs, as well as a generous tuition reimbursement program. An application, references,

More information

Home Health Care in Florida

Home Health Care in Florida Consumer Awareness Brochure Home Health Care in Florida The Florida Agency for Health Care Administration (AHCA) is designated as the chief health policy and planning entity for the state and licenses

More information

Medical Claim Submissions

Medical Claim Submissions Medical Claim Submissions New CMS 1500 Claim Form Requirements 10/28/2015 Hewlett Packard Enterprise 1 Learning objectives Understand the new requirements and deadlines Understand how to complete the new

More information

Preventive Medicine and Screening Policy

Preventive Medicine and Screening Policy REIMBURSEMENT POLICY Policy Number 2015R0013C Preventive Medicine and Screening Policy Annual Approval Date 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT

More information

Broward Health s Breast Cancer Navigation Program Meeting the needs of underserved patients

Broward Health s Breast Cancer Navigation Program Meeting the needs of underserved patients Broward Health s Breast Cancer Navigation Program Meeting the needs of underserved patients by Pia Delvaille, ARNP, MSN Broward Health, a nonprofit community health system, is one of the ten largest public

More information