Where within the claim form should an MDPP supplier include the Demonstration Code "82"?
MDPP suppliers should report Demonstration Code "82" in Item 19 on the CMS-1500 claim form or in the EDI equivalent 2300 REF01 P4 and 2300 REF02 82.
What is the average time for response to a submitted claim? Meaning, the turnaround time (e.g., 30, 45, or 60-day time window)?
Electronic claims, 14 days; paper would be 29. Best practice is to wait 30 days for claim finalization prior to resubmitting.
What HCPCS codes should be used for MDPP reporting?
CMS has developed billing and coding cheat sheets to assist with reporting. See the 2024 MDPP billing and claims cheat sheet for the list of current codes.
Reference
How often are MDPP suppliers required to update their coach roster?
MDPP suppliers must update changes to the coach roster in PECOS within 30 calendar days to avoid claims being rejected or denied.
Reference
What is your policy for deactivating MDPP suppliers, within a specific time period, that do not submit claims (i.e., what is the time period)?
CMS is responsible for sending the deactivation lists to the MAC. They could request for a provider to be deactivated for not billing any claims for six months or longer.
PC-ACE User Guide: PC-ACE quick steps
Below are quick steps for setting up and using the PC-ACE program after it has been installed. For instructions to download the...
PC-ACE User Guide: Section 10 - Exiting PC-ACE including backup/restore
To exit the PC-ACE software program
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Click on the word File from the PC-ACE Main Toolbar and click on Exit.
You will be prompted...
PC-ACE User Guide: Section 9 - Electronic reports
EDI Services generates multiple reports to assist you in easily tracking your electronic claims. These reports represent...
PC-ACE User Guide: Section 8 - Connect to First Coast
Once claims have been entered, the next step is to connect to First Coast. To do this, you will need a Network Service Vendor...
PC-ACE User Guide: Section 7 - Prepare/Reactivate claims for transmission
Prepare new claim for transmission
- Click the Institutional or Professional Claims Processing icon from the PC-ACE Main Toolbar.
- Cl...