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CHAMPVA claim submission and appeal submission address
Claims for CHAMPVAThe Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) isnot a TRICARE program. For questions or general correspondence, you may contact CHAMPVAby any...
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E” Code is Reported as the First Diagnosis and CPT 88305 - correct way
Proper billing of CPT code 88305Providers are incorrectly coding claims when billing for multiple specimens of CPT® code 88305. Multiple specimens for the same date of service, billed on the same...
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what is PQRS
Physician Quality Reporting SystemThe Physician Quality Reporting System (previously known as the Physician Quality ReportingInitiative or PQRI) is a voluntary reporting program that provides a...
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How much incentive payment for PQRS program
How much is the payment?A participating individual eligible professional or group practice who satisfactorily reports data onPhysician Quality Reporting System quality measures may earn an incentive...
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How much the penalty adjustment payment under ERx incentive program.
How much is the payment?An individual eligible professional may qualify to earn an incentive payment or receive a paymentadjustment equal to a percentage of the total estimated Medicare Part B allowed...
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Medicaid update - Limit on office visit - General physician
General Physician Visit ExceptionBeginning August 1, 2012, reimbursement for procedure codes 99201-99215 is limited to two per month for general services. This affects the following provider types and...
View ArticleNew CPT code update on year 2013
New codes for Evaluation and Management servicesComplex Chronic care coordination service99487 Complex chronic care coordination services; first hour of clinical staff time directed by a physician or...
View ArticleEmergency department CPT codes - 99281, 99282, 99283
99281 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward...
View ArticleBCBS of Texas - Accepted modifier
MODIFIERS – Professional ClaimsBlueCross and BlueShield of Texas/HMO Blue Texas accept all valid CPT and HCPCS modifiers into the claims processing systems.The following modifiers have logic associated...
View ArticleWhy we using modifier - Most used modifiers
Why use a modifier? • to indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code. • may use a...
View ArticleMedicare EFT form submission instruciton
From Medicare website you can download the form. For Florida state, I have given the link.http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/CMS588.pdfINSTRUCTIONS FOR COMPLETING THE EFT...
View ArticleHow to deal COB, thirty party liability claims
Coordination of BenefitsCoordination of Benefits (COB) is the process used to process health care payments when a member has coverage with more than one insurer. When it is identified that a member has...
View ArticleWhat is Chronic care choice plan- overview
Chronic Care ChoicesThis benefits package includes individuals with chronic care disease states who are the most medically vulnerable of our population and who require intensive care. Consequently,...
View ArticleWhat are Primary Care Physician Responsibilities
Primary Care Physician ResponsibilitiesThe Primary Care Physician will provide Plan members with a medical home and is responsible for coordinating the member’s medical care, which includes the...
View ArticleGolden Rule insurance address changd - new address
Please note that Golden Rule Insurance Company has a new mailing address. Therefore, weask that you update your records as soon as possible to replace our previous mailing addressesfor submitting...
View ArticleModifiers for Special Situations in Hospice
Special modifiers should be used for the following circumstances [MCM 4175.1, 4175.2]: ** If another physician covers for the designated attending physician, the services of the substituting physician...
View ArticleREPORTING OCCURRENCES TO THE PLAN
As part of the CarePlus Risk Management Program physicians and other health care providers are expected to report any occurrences and/or adverse incidents of a plan member, whether it...
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How many days before patient can be scheduled ?
Appointment Scheduling Member appointments should be scheduled according to necessity of member needs (e.g.emergent, urgent, or routine/well care visits). As a general rule, for routine...
View ArticleMedicare SPOT - website FAQ
First Coast Service Options Inc. (First Coast) developed its provider Internet portal -- Secure Provider Online Tool (the SPOT) -- to offer providers faster access to claims information,...
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