Claims
Automated Process for Multiple PTAN Matches to Single NPI will Reduce Claim Processing Delays: Part A
Part A providers with multiple facility PTANs linked to a single NPI, learn about our automated process to match the most appropriate PTAN to your NPI.
Process for Supplying Invoice Amount on Certain HCPCS Codes - Avoid Rejected Claims
Please review the revised drug codes list; Q5155 has been updated.
Outlier Claim Information and Submission Instructions
To qualify as an outlier, the claim must have costs above a fixed loss threshold amount. CMS publishes the amount in the annual Inpatient Prospective Payment System (IPPS) Final Rule.
Appropriate Drug Billing Part B
Read this article to learn more about appropriately billing Part B drugs.
Reason Code 34929 - Acute Care Claims Must Contain a Valid Present on Admission (POA) Indicator
Review this article to resolve reason code 34929.
Hardcopy Claim Submission Exceptions and Required Cover Form
This article describes hardcopy claim submission exceptions and the required coversheet for hardcopy UB-04 form submissions.
Reason code W7087 and Medically Denied Lines for Skin Substitute Services
Reason code W7087 is received when a skin substitute application procedure is billed without the appropriate skin substitute product code. This edit causes claims to return to the provider (RTP) as…
Current Processing Issues
Incorrect duplicate denials have occurred for chronic care management (CCM) and remote physiological management (RPM) services billed on the same date of service as an E/M visit. Incorrectly denied…