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Credit balance reporting
Details on submitting the credit balance report, submission deadlines, and a tool to check credit balance status.
MLN Connects for July 10, 2025
This edition includes information on hospital price transparency, providers accepting CHAMPVA, a Medicare fraud alert, and more.
MLN Connects for July 10, 2025
This edition includes information on hospital price transparency, providers accepting CHAMPVA, a Medicare fraud alert, and more.
Skilled nursing facility (SNF) 5-claim probe and educate (P&E) round results
View this article to view the results for the SNF 5-claim probe and educate (P&E).
Revised coversheets are now available for PAR OPD submissions: Learn about the new fields to avoid delays
Effective December 9, both the standard and expedited PAR coversheets are updated with new fields to improve the prior authorization request (PAR) process. These fields include selection of modifiers…
Revised coversheets are now available for PAR OPD submissions: Learn about the new fields to avoid delays
Effective December 9, both the standard and expedited PAR coversheets are updated with new fields to improve the prior authorization request (PAR) process. These fields include selection of modifiers…
UB-04 billing information
The Official UB-04 Data Specifications Manual 2025, copyrighted by the American Hospital Association, is the only official source of UB-04 billing information adopted by the National Uniform Billing…
Good cause for extension of the time limit for filing appeals
The time limit for filing a request for redetermination may be extended in certain situations. Good cause may be found when the record clearly shows, or the provider, physician or other supplier…
Modifier 53 fact sheet
To avoid claim denials and future appeals due to these incorrect claim submissions, we’re providing guidance on how to properly submit a claim when applying this modifier.
Provider Reimbursement Manual
View various sections of the Provider Reimbursement Manual applicable to audit and reimbursement.