Claim Filing Indicator. Payer Responsibility. Taxonomy for occupational therapist. When using a consolidated NPI, a table will display showing the locations and taxonomy code(s) information on file with MHCP. Principal Diagnosis Code. Adjudication - Payment Date. Other Providers (Claim Level) – Select the Other Providers accordion screen when required to report other provider information. This is the code indicating whether the provider accepts payment from MHCP.
Home Care Servies Billing Codes. Enter the highest level of ICD or other industry accepted code(s) that best describe the condition/reason the recipient needed the service(s). The zip code for the address in address fields 1 and 2. Submitting an 837I Outpatient Claim. Skilled Nurse Visit Telehomecare. Taxonomy code for occupational therapist. For header (claim) level adjustment, select the code identifying the general category of the payment adjustment for this line from the dropdown menu options. Diagnosis Type Code. 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. From the dropdown menu options, select the code identifying type of insurance.
The patient control number will be reported on your remittance advice. Pro cedure Code Modifier(s). When reporting TPL adjustments at the claim (header level), enter the prior payer paid amount. The second address line reported on the provider file. Enter the quantity of units, time, days, visits, services or treatments for the service. The middle initial of the subscriber. Taxonomy code for occupational therapy.com. Enter the NPI listed on the Explanation of Medicare Benefits (EOMB) used to submit the claim to Medicare. 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. Situational (Continued) Claim Information. Other Payers Claim Control Number. Once the claim filing indicator is selected, additional fields will display for reporting TPL/private insurance.
This is available on the recipient's eligibility response). The last name of the subscriber. Coordination of Benefits (COB). When reporting TPL at the claim (header level), enter the non-covered charge amount.
G0154 (through 12/31/15). Other Payer – Use this accordion screen when reporting COB at the line level for either (Medicare Part B and/or TPL). From the dropdown menu options, select the relationship of the MHCP subscriber (recipient) to the policy holder. Select one of the follwoing: Other Payer Na me.
Service Line Paid Amount. Enter the name of the TPL insurance payer. Enter the service end date or last date of services that will be entered on this claim. The following fields auto-populate based on the information entered in the Subscriber ID and Birth Date fields: Subscriber First Name.
Prior Authorization Number. Enter the total dollar amount the other payer paid for this service line. C laim Adjustment Group Code. Respiratory Therapy Visit Extended. Enter the total dollar amount of the specific adjustment for the reason code entered on this service line. Enter the name of the Medicare or Medicare Advantage Plan. Non-Covered Charge Amount. Section Action Buttons. Select the appropriate source code from the dropdown menu options, indicating the point of location/origin for this admission or visit. Home Health Aide Visit. Telephone number reported on the provider file. 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.
Select the radio button next to the location where the service(s) was provided. Select one of the following: Subscriber. Enter the total adjusted dollar amount for this line. If different than the provider reported on the claim information screen: Select one of the following screen action buttons: Note: You must always select Save/View Lines(s) after entering all lines to see the validate and submit action buttons. For new or current patients enter "1"). Copy, Replace or Void the Claim. Enter the policy holder's identification number as assigned by the payer.
Statement Date (To). Enter the Identifier of the insurance carrier. 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. This is the determination of whether the provider has a signed statement by the recipient on file, authorizing the release of medical data to other organizations.
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