Claim submission guidelines
Guidelines for billing acute inpatient noncovered days
This article provides guidance for billing provider-liable acute inpatient non-covered and acute partial inpatient non-covered days, and acute inpatient non-covered beneficiary-liable days.
Incarcerated beneficiary
View these guidelines for a beneficiary who is incarcerated or in custody at the time items and services are furnished.
Incarcerated beneficiary
View these guidelines for a beneficiary who is incarcerated or in custody at the time items and services are furnished.
Method II critical access hospital: Professional billing requirements for emergency department services
New section, Emergency department procedure codes for Method II CAH, added to the Medicare Claims Processing Manual Pub.100-04, chapter 4, section 250.18.
EDI: CMS-1450 paper claim to electronic claim crosswalk (5010)
The following article provides the requirements of the form locators within the CMS-1450 (UB-04) paper claim form and their electronic equivalents.
Submitting claims when the dollar amount exceeds $99,999.99
First Coast has seen an increase in claims for drugs, hemophilia clotting factors, and skin substitutes that exceed the dollar amounts above $99,999.99. Effective for claims received on or after…
Medically Unlikely Edits: Avoid denials and appeals by properly coding the first time
First Coast wants you to prevent claim denials or appeals by coding the appropriate number of units correctly the first time.
Medically Unlikely Edits: Avoid denials and appeals by properly coding the first time
First Coast wants you to prevent claim denials or appeals by coding the appropriate number of units correctly the first time.
Institutional billing resources (Addendums A, B, D1 and E*)
To bill correctly under the Outpatient Prospective Payment System (OPPS), please review the addendums* listed below.