SPOT features and functionality |
Part A |
Part B |
Appeal request via claim status Check the status of a claim as well as submit level 1 (redeterminations) and level 2 (reconsiderations) appeal requests |
X |
|
Appeal status Obtain information regarding status of appeals, including the outcome of the appeal |
X |
X |
Appeals outcome Obtain the outcome of appeal decisions by viewing copies of the redetermination notices |
X |
X |
Obtain account receivable details including recoupment, adjustment, collection amounts, and duplicate demand letters |
X |
X |
Claim reopening request Submit a request for a reopening to be performed |
X |
X |
Claim status Obtain the status of a claim that is accepted into the claim processing system |
X |
X |
Comparative billing report (CR) Obtain reports, which provide insight into billing trends, and assist providers with self-audits of procedures and billing practices |
X | |
EDI form request Request an update to the EDI enrollment information |
X |
X |
Eligibility Check patient eligibility and obtain benefit details |
X |
X |
MBI lookup tool Look up patient Medicare beneficiary identifier (MBI) numbers |
X |
X |
Medical review claims View additional documentation request (ADR) status and dates, copies of ADR letters, and status and outcome of the review |
X |
X |
Medical review records submission Submit requested medical review records in response to ADR letters |
X |
X |
MSP overpayment form Submit a request for an MSP overpayment to be performed |
X | |
Non-MSP overpayment form Submit a request for a non-MSP overpayment to be performed |
X | |
Overpayment correction Report a duplicate claim, services not rendered, or other correction on a single line or full claim. |
X | |
Overpayment letters View, save, or print copies of overpayment letters |
X |
X |
Payment status Obtain check information such as check number, amount, dates, and check status. |
X |
X |
Prior authorization request submissions Part A and B: • Hospital outpatient department (OPD) services Part B only: • Submit prior authorization requests for Part B repetitive non-emergent ambulance transportation |
X |
X |
Retrieve remittance advice copies View, save, or print copies of the remittance like the standard paper remittance (SPR) |
X |
X |
Submit 1099 forms Submit request for 1099 copies, corrections or to dispute the information |
X |
X |
Submit appeal requests Submit appeal requests with documentation |
X |
X |
Submit general information requests Submit general inquiries such as questions related to coverage guidelines, policy issues, or how to bill Medicare |
X |
X |
Submit Provider Audit & Reimbursement documents Submit documentation to Provider Audit & Reimbursement including supplemental security income (SSI) realignment requests, wage index/occupational mix submissions, cost report reopening requests, and more |
X |