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The last name of the subscriber. Select Submit to identify if the claim will be paid, denied, or suspended for review at the claim and service line level of the claim. Use only when a modifier is listed on the service authorization (SA) or when a claim for private duty nursing shared services. Taxonomy code occupational therapy. Enter the HCPCS code identifying the product or service. Enter the name of the TPL insurance payer. Private Duty Nursing RN.
To delete, select Delete. Enter the code identifying the reason the adjustment was made. This must be the date the determination was made with the other payer. Enter the code identifying the general category of the payment adjustment for this line. Telephone number reported on the provider file. Select one of the following: Subscriber. List of cpt codes for occupational therapy. Coordination of Benefits (COB). From the dropdown menu options, select the appropriate code indicating the disposition or discharge status of the recipient on the date entered in the statement Date (To) field. Home Care Servies Billing Codes. Home Health Aide Visit Extended (waivers).
Select the appropriate source code from the dropdown menu options, indicating the point of location/origin for this admission or visit. Enter the 8-digit MHCP ID for the subscriber (recipient) indicated on the MHCP member identification card. Respiratory Therapy Visit Extended. When reporting TPL adjustments at the claim (header level), enter the prior payer paid amount. This code must match the HCPCS code entered on your service authorization (SA). Release of Information. Other Providers (Claim Level) – Select the Other Providers accordion screen when required to report other provider information. The name of the Billing Provider: This could be an Organization, business or the Name of an individual provider identified by the NPI used to lo gin to MN– ITS. Non-Covered Charge Amount. When reporting TPL at the claim (header level), enter the non-covered charge amount. Use only when submitting a claim with an attachment. Taxonomy code for occupational therapy.com. Use the Washington Publishing Company (WPC) health care codes lists to identify the claim status category and claim status codes displayed on the validate and submit claim response. Enter the total dollar amount of the specific adjustment for the reason code entered on this service line. Benefits Assignment.
Copy, Replace or Void the Claim. Use the Home Care Service Billing Codes in the chart below to determine the revenue code used for MHCP home care services. For header (claim) level adjustment, select the code identifying the general category of the payment adjustment for this line from the dropdown menu options. Once the claim filing indicator is selected, additional fields will display for reporting TPL/private insurance. Enter the unit(s) or manner in which a measurement has been taken. Submitting an 837I Outpatient Claim. Assignment/ Plan Participation. Payer Responsibility. Enter the highest level of ICD or other industry accepted code(s) that best describe the condition/reason the recipient needed the service(s). Principal Diagnosis Code. C laim Adjustment Group Code. Enter the total dollar amount the other payer paid for this service line. Adjustment Reason Code.
For Medicare this would be the Medicare health insurance claim number (HICN) or the Medicare beneficiary identifier (MBI) number. Enter the total charge for the service. An authorization number is required when an authorization is already in the system for the recipient. To (End) date not required as must be the same as the From (start) date of this line. Attachment Control Number. Home Care (Non-PCA) Services. An authorization number is not required if there is no authorization in the system and the service is a skilled nurse visit. Enter the total adjusted dollar amount for this line. Enter the claim number reported on the Medicare EOMB. Other Payer Primary Identifier. From the dropdown menu options, select the code identifying type of insurance. The following fields auto-populate based on the information entered in the Subscriber ID and Birth Date fields: Subscriber First Name. The patient control number will be reported on your remittance advice. This is the determination of the policy holder or person authorized to act on their behalf, to give MHCP permission to pay the provider directly.
Situational (Continued) Claim Information. Other Payer – Use this accordion screen when reporting COB at the line level for either (Medicare Part B and/or TPL). Other Payers Claim Control Number. Other Providers- Select the Other Providers accordion panel when required to report other provider information on the service line, if different than what was reported at the claim level. The first 9 skilled nurse visits in a calendar year do not require an authorization unless the recipient has a current waiver service authorization SA)]. Enter the date of payment or denial determination by the Medicare payer for this service line. Dates must be within the statement dates enterd in the Claim Information Screen. From the dropdown menu options, select the code identifying the insurance carrier's level of responsibility for payment.