Select the appropriate source code from the dropdown menu options, indicating the point of location/origin for this admission or visit. Use the Home Care Service Billing Codes in the chart below to determine the revenue code used for MHCP home care services. From the dropdown menu options, select the relationship of the MHCP subscriber (recipient) to the policy holder. 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. Occupational medicine taxonomy code. When using a consolidated NPI, a table will display showing the locations and taxonomy code(s) information on file with MHCP. The zip code for the address in address fields 1 and 2. Respiratory Therapy Visit Extended.
From the drop down menu, select whether the diagnosis code reported on this claim is in the ICD-9 or ICD-10 classification. 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 8-digit MHCP ID for the subscriber (recipient) indicated on the MHCP member identification card. Use only when submitting a claim with an attachment. Enter the total dollar amount of the specific adjustment for the reason code entered on this service line. C laim Adjustment Group Code. Use only when a modifier is listed on the service authorization (SA) or when a claim for private duty nursing shared services. Enter the date associated with the Occurrence Code. Pro cedure Code Modifier(s). For new or current patients enter "1"). Service Line Paid Amount. Taxonomy for occupational therapist. Enter the NPI listed on the Explanation of Medicare Benefits (EOMB) used to submit the claim to Medicare. Enter the date the item or service was provided, dispensed or delivered to the recipient.
Submitting an 837I Outpatient Claim. The following fields auto-populate based on the information entered in the Subscriber ID and Birth Date fields: Subscriber First Name. Occupational therapy assistant taxonomy code. Copy, Replace or Void the Claim. Enter the quantity of units, time, days, visits, services or treatments for the service. This is available on the recipient's eligibility response). Situational (Continued) Claim Information. The patient control number will be reported on your remittance advice.
Attachment Control Number. Once the claim filing indicator is selected, additional fields will display for reporting TPL/private insurance. To (End) date not required as must be the same as the From (start) date of this line. Adjudication - Payment Date. Enter the claim number reported on the Medicare EOMB. Section Action Buttons. When appropriate, enter the service authorization (SA) number. Enter the name of the TPL insurance payer. 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. 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. 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. Enter a unique identifier assigned by you, to help identify the claim for this recipient.
Adjustment Reason Code. Enter the HCPCS code identifying the product or service. Select the appropriate response from the dropdown menu options, to identify the priority of the admission/visit. An authorization number is not required if there is no authorization in the system and the service is a skilled nurse visit. Enter the code identifying the reason the adjustment was made. Situational Claim Information - Select the situational claim information accordion screen to report situational information when required. Other Payer – Use this accordion screen when reporting COB at the line level for either (Medicare Part B and/or TPL). Telephone number reported on the provider file. Enter the date of payment or denial determination by the Medicare payer for this service line. Enter the appropriate revenue code used to specify the service line item detail for a health care institution. Enter the total charge for the service. Skilled Nurse Visit (LPN). Line Item Charge Amount. Regular Private Duty RN.
Date of Service (From). This code must match the HCPCS code entered on your service authorization (SA).
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