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To determine if a claim was medically reviewed, providers should submit the requests correctly.
Are you providing outpatient therapy services on institutional claims and receiving reason code 34963 indicating the attending physician is invalid? Read this article for assistance to resolve your claim returns.
This information outlines the process for the 935 recoupment.
This article is a reminder for all outpatient claim submitters about how to correctly submit the date of service on the claim.
Medical documentation from ordering physicians plays a vital role in validating medical necessity of ordered laboratory tests.
This article informs you and your vendors about changes that will allow you to request reopening of claims electronically.
Effective April 1, CMS implemented a new consistency edit to validate the attending physician NPI. Claims are returning with reason code 34963. Read on for more information.
CMS provided clarification regarding the Medicare guidance relating to complex administration CPT codes 96401-96549. Please read this article for more information.
This article provides guidance to avoid inappropriately billing Qualified Medicare Beneficiaries (QMBs) for Medicare cost-sharing, including deductibles, coinsurance, and copayments.
The January Integrated Outpatient Code Editor (IOCE) expands editing related to manifestation diagnosis codes. Read this article to find out more about the editing.