Encounter Data System Test Case Specifications
|
|
- Melvyn Russell
- 5 years ago
- Views:
Transcription
1 Encounter Data System Test Case Specifications Encounter Data PACE Test Case Specifications related to the 837 Health Care Claim: Professional Transaction based on ASC X12 Technical Report Type 3 (TR3), Version X222A1 Test Case Specifications: 2.0
2 Preface The Encounter Data System (EDS) Test Case Specifications contain information to assist PACE organizations in the submission of encounter data for EDS testing. Following the completion of unique encounter data submissions for Encounter Data Front End System (EDFES) testing, PACE organizations are required to submit data for testing the Encounter Data Processing System (EDPS). This document provides an outline of test case submissions required for PACE end-to-end testing. Questions regarding the contents of the EDS Test Case Specifications should be directed to 2
3 REVISION HISTORY Version Date Organization/Point of Contact Description of Changes /20/12 ARDX Base Document /28/12 ARDX TC03-Capitated Provider Submission and TC11-Bundled Payment were removed from the test case specifications and the total number of test cases has been modified to reflect a total of 12 cases. 3
4 Table of Contents 1.0 Overview 2.0 Introduction 3.0 Test Case Details 4.0 Acronyms 4
5 1.0 Overview This document may be used in conjunction with the business case examples referenced in the EDS 837 Professional Transaction Companion Guide. Additional Test Scenario Specification documents may be incorporated and referenced at a later date. The purpose of EDS end-to-end testing is to validate the following: Files are received by the EDFES Files are processed through the translator Files are processed through the CEM Submitter receives acknowledgment reports (TA1, 999, 277CA) from the EDFES EDFES data are received by the Encounter Data Processing System (EDPS) Data are processed and priced in the EDPS Submitter receives Encounter Data Processing Status MAO-002 from the MAO-002 from the EDPS 5
6 2.0 Introduction CMS has provided the submission guidelines for end-to-end testing, to include test cases necessary for PACE testing. PACE testing is intended to allow PACE organizations the ability to determine system performance based on the submission of non-pace day care center services. Non-PACE day care center services are submitted on an inpatient or outpatient Institutional or Professional claim form. Professional encounter testing begins 11/16/2012 and ends 12/31/ Professional End-to-End Testing The 837-P certification files are submitted in two (2) files. The first file includes all unlinked test cases (8) and the second file includes the linked test cases (4). All test cases included in the first file must be completely accepted as indicated on the MAO-002 report before the second file is submitted. PACE organizations must receive a 95% acceptance rate to be deemed certified. The first test file must include the 16 encounters (2 encounters per test case) otherwise EDS will reject the file. Rejected files must be corrected and resubmitted until all 16 encounters pass translator and CEM editing at 100% before it can be processed in the EDPS. PACE organizations must use the following guidance when preparing all unlinked (8) and the linked (4) test cases: The encounters submitted must comply with the TR3, CMS edits spreadsheet and Encounter Data Companion Guide. All encounters must include 2012 DOS only (no future dates). Files must be identified as a test case submission using ISA15= T and CLM01 by appending TC<test case #> to the end of the Plan Encounter ID (CCN). PACE organizations must not submit any Institutional or DME test cases with the Professional file submissions. PACE organizations should exclude PACE center services at this time. PACE organizations will receive the TA1, 999, and 277CA within 48 hours of submission. The MAO- 002 report will be returned to the submitter within seven (7) business days of EDFES submission receipt. PACE organizations must correct errors identified on the reports and resubmit data with a 95% acceptance rate in order to pass end-to-end certification. Acceptance notifications will be communicated to MAOs and other entities upon certification. 6
7 2.2 Test Case Summary During the end-to-end testing, the following types of test case scenarios are required: I. Beneficiary Eligibility a. Standard MA Member Submission II. III. IV. Provider Data Validation Submissions a. Atypical Providers b. Ambulance TOS c. Coordination of Benefits (COB) Processing a. Correct/Replace b. Void/Delete c. Chart Review Linked d. Chart Review Unlinked e. Duplicate f. Paper Generated g. Zip Code + 4 Risk Adjustments a. Diagnoses not included in the model diagnoses 7
8 Test Case Summary Table Test Case/Script Identifier Test Case/Script Title Beneficiary Eligibility-Current MA Member TC01-Standard MA Member Submission Provider Data Validation TC02-Atypical Provider Submission Provider Data Validation TC03-Ambulance TOS Submission Provider Data Validation TC04-Coordination of Benefits Submission Encounter File TC05-Correct/Replace Encounter File TC06-Void/Deleted Encounter File TC07-Chart Review Linked Encounter File TC08-Chart Review Unlinked Encounter File TC09-Duplicate Encounter File TC10-Paper Generated Encounter File TC11-Zip Code +4 Risk Adjustment TC12-Diagnoses Included in Model Diagnosis Codes 8
9 For each test case scenario, details are provided to assist with encounter data test submissions: Type of test encounter requested for testing. This line defines the purpose for testing this type of encounter. Prerequisite Conditions list requirements and reminders to successfully submit the test encounter. This section provides steps for inputs and the expected outcomes from the submissions. This section lists any assumptions or constraints associated with the Test Case. 9
10 3.0 Test Case Details 3.1 TC01-Standard MA Member Submission Purpose The purpose of TC01-Standard MA Member Submission is to test eligibility rules for a standard Medicare Advantage encounter submission Prerequisite Conditions 1. System will accept 5010 version X12 standards for HIPAA transactions in the 837-P format. 2. At least two (2) encounters are submitted for each type of test case scenario Test Procedure Table 1: Test Procedure Steps for TC01-Standard MA Member Submission Step # Action Expected Results/ Evaluation Criteria 1. Submit an encounter for a standard Medicare Advantage member. The 999A and 277CA Reports are returned within 24 hours of submission. Validation on the file for a unique encounter is based on the following data fields: o Beneficiary HICN o Beneficiary Last Name o Date of Service o Place of Service o Type of Service o Procedure Code (and 4 modifiers) o Rendering Provider NPI o Paid Amount Files pass duplicate validation, paid amount balancing and continue processing. ED Processing Status Report is returned with Accepted status within seven (7) business days of submission. Any errors found on the file will generate the ED Processing Status Report with a Rejected status within seven (7) business days of submission 10
11 3.1.4 Assumptions and Constraints It is assumed that all beneficiaries are eligible and enrolled in the plan and can be found in enrollment reports and table for verification. 11
12 3.2 TC02-Atypical Provider Submission Purpose The purpose of TC02-Atypical Provider Submission is to test encounters submitted by atypical providers with the designated default NPI and tax ID number for editing, processing, and appropriate pricing of submissions Prerequisite Conditions 1. System will accept 5010 version X12 standards for HIPAA transactions in the 837-P format. 2. At least two (2) encounters are submitted for each type of test case scenario Test Procedure Table 2: Test Procedure Steps for TC02-Atypical Provider Submission Step # Action Expected Results/ Evaluation Criteria 1. Submit an atypical provider 837-P file using the following default codes: Payer ID NPI EIN ICD-9 diagnosis code: Other General Symptoms Loop 2300, NTE01= ADD, NTE02= NO NPI ON PROVIDER CLAIM NO EIN ON PROVIDER CLAIM The 999A and 277CA Reports are returned within 24 hours of submission. Validation on the file for a unique encounter is based on the following data fields: o Beneficiary HICN o Beneficiary Last Name o Date of Service o Place of Service o Type of Service o Procedure Code (and 4 modifiers) o Rendering Provider NPI o Paid Amount Files pass duplicate validation, paid amount balancing and continue processing. ED Processing Status Report is returned with Accepted status within seven (7) business days of submission. Any errors found on the file will generate the ED Processing Status Report with a Rejected status within seven (7) business days of submission 12
13 3.2.4 Assumptions and Constraints The default diagnosis codes provided are only used for testing purposes. Relevant diagnosis codes should be determined by coordinating with the provider and atypical service provider. Diagnoses captured from atypical provider types (as notated by the default atypical provider NPI) will not be priced or used for risk adjustment calculation; however, it will be stored for beneficiary utilization data and analysis. 13
14 3.3 TC03-Ambulance TOS Submission Purpose The purpose of TC03-Ambulance TOS Submission is to test editing, processing, and appropriate pricing of ambulatory services Prerequisite Conditions 1. System will accept 5010 version X12 standards for HIPAA transactions in the 837-P format. 2. At least two (2) encounters are submitted for each type of test case scenario. 3. Remember to submit an NPI that is valid for an ambulance type of service and the HCPCS codes listed are valid for ambulatory services. 4. Ensure a valid zip code is included in the submission file Test Procedure Table 3: Test Procedure Steps for TC03-Ambulance TOS Submission Step # Action Expected Results/ Evaluation Criteria 1. Submit an encounter with a valid pick-up service address in Loop 2310E and drop-off address in Loop 2310F. The 999A and 277CA Reports are returned within 24 hours of submission. Validation on the file for a unique encounter is based on the following data fields: o Beneficiary HICN o Beneficiary Last Name o Date of Service o Place of Service o Type of Service o Procedure Code (and 4 modifiers) o Rendering Provider NPI o Paid Amount Files pass duplicate validation, paid amount balancing and continue processing. ED Processing Status Report is returned with Accepted status within seven (7) business days of submission. Any errors found on the file will generate the ED 14
15 Step # Action Expected Results/ Evaluation Criteria Processing Status Report with a Rejected status within seven (7) business days of submission Assumptions and Constraints The ambulance fee schedule will be used for pricing all services identified on the encounter submission. 15
16 3.4 TC04-Coordination of Benefits Submission Purpose The purpose of TC04-Coordination of Benefits Submission is to test editing, processing, and appropriate pricing of multi-payer or Medicare secondary payer submissions Prerequisite Conditions 1. System will accept 5010 version X12 standards for HIPAA transactions in the 837-P format. 2. At least two (2) encounters are submitted for each type of test case scenario. 3. Submit an original transaction to a primary payer Test Procedure Table 4: Test Procedure Steps for TC04-Coordination of Benefits Submission Step # Action Expected Results/ Evaluation Criteria 1. Submit a true coordination of benefits submission using the following guidance: 1st iteration of COB loops MAO information (Primary Payer) Loop 2320 AMT01= D, AMT02=MAO Paid Amount Loop 2330B MAO Information Loop 2430 MAO Service Line Adjudication Information SVD Service Level Payment Amount CAS Service Level Amount NOT Paid The 999A and 277CA Reports are returned within 24 hours of submission. Validation on the file for a unique encounter is based on the following data fields: o Beneficiary HICN o Beneficiary Last Name o Date of Service o Place of Service o Type of Service o Procedure Code (and 4 modifiers) o Rendering Provider NPI o Paid Amount Files pass duplicate validation, paid amount balancing and continue processing. ED Processing Status Report is returned with Accepted status within seven (7) business days of submission. Any errors found on the file will generate the ED Processing Status Report with a Rejected status within seven (7) business days of submission. 16
17 Step # Action Expected Results/ Evaluation Criteria 2nd iteration of COB loops True COB (Tertiary Payer) Loop 2320 AMT01= D, AMT02=True COB Paid Amount CAS Claim Level Amount NOT Paid by True COB Loop 2330B Other Payer Information DTP*573-Other Payer Adjudication Date *NOTE there is NO True COB Service Level Payment Amount information Assumptions and Constraints There are no assumptions and constraints identified at this time for coordination of benefits submissions. 17
18 3.5 TC05-Correct/Replace Purpose The purpose of TC05-Correct/Replace is to test for editing, processing, and appropriate pricing of replacement submissions Prerequisite Conditions 1. System will accept 5010 version X12 standards for HIPAA transactions. 2. The original submission must be identified as Accepted status on the ED Processing Status Report. This submission must be sent with the ICN associated with the Accepted encounter. 3. At least two (2) encounters are submitted for each type of test case scenario Test Procedure Table 5: Test Procedure Steps for TC05-Correct/Replace Step # Action Expected Results/ Evaluation Criteria 1. Submit an encounter with a correction/replacement code 7 in Loop 2300, CLM05-3 on the 837-P. Populate Loop 2300, REF01= F8 and REF02 = ICN of the prior encounter. The 999A and 277CA Reports are returned within 24 hours of submission. Validation is performed against the original encounter stored in the EODS: o Loop 2300 REF01=F8 REF02=ICN Validation on the file for a unique encounter is based on the following data fields: o Beneficiary HICN o Beneficiary Last Name o Date of Service o Place of Service o Type of Service o Procedure Code (and 4 modifiers) o Rendering Provider NPI o Paid Amount Files pass duplicate validation, paid amount balancing and continue processing. ED Processing Status Report is returned with 18
19 Step # Action Expected Results/ Evaluation Criteria Assumptions and Constraints Accepted status within seven (7) business days of submission. Any errors found on the file will generate the ED Processing Status Report with a Rejected status within seven (7) business days of submission. It is assumed that MAOs have access to the CMS website where diagnosis models for risk adjustments are available as a reference. There are no constraints identified for the submission of a replacement encounter. 19
20 3.6 TC06-Void/Deleted Purpose The purpose of TC06-Void/Deleted submission is to ensure an original encounter is deleted from the system Prerequisite Conditions 1. System will accept 5010 version X12 standards for HIPAA transactions. 2. The original submission must be identified as Accepted status on the ED Processing Status Report. This submission must be sent with the ICN associated with the Accepted encounter. 3. At least two (2) encounters are submitted for each type of test case scenario Test Procedure Table 6: Test Procedure Steps for TC06-Void/Deleted Step # Action Expected Results/ Evaluation Criteria 1. Submit an encounter with a void/deleted code 8 in Loop 2300, CLM05-3 on the 837-P. Populate Loop 2300, REF01= F8 and REF02 = ICN of the prior encounter. The 999A and 277CA Reports are returned within 24 hours of submission. Validation on the file for a unique encounter is based on the following data fields: o Beneficiary HICN o Beneficiary Last Name o Date of Service o Place of Service o Type of Service o Procedure Code (and 4 modifiers) o Rendering Provider NPI o Paid Amount Files pass duplicate validation, paid amount balancing and continue processing. ED Processing Status Report is returned with Accepted status within seven (7) business days of submission. Any errors found on the file will generate the ED Processing Status Report with a Rejected status within seven (7) business days of submission 20
21 3.6.4 Assumptions and Constraints It is assumed that any information that is incorrect for a void/deleted submission is captured and rejected at the CEM/CEDI edit level therefore would reach the processing level. There are no constraints identified for the submission of a deletion file. 21
22 3.7 TC07-Chart Review Linked Purpose The purpose of TC07-Chart Review Linked submission is to ensure supplemental chart review information associated with an encounter is captured in EODS for editing, processing, and appropriate pricing of submissions Prerequisite Conditions 1. System will accept 5010 version X12 standards for HIPAA transactions. 2. The original submission must be identified as Accepted status on the ED Processing Status Report. This submission must be sent with the ICN associated with the Accepted encounter. 3. At least two (2) encounters are submitted for each type of test case scenario. 4. Remember to include a valid Provider Tax ID and the Rendering Provider NPI number Test Procedure Table 7: Test Procedure Steps for TC07-Chart Review Linked Submission Step # Action Expected Results/ Evaluation Criteria 1. Submit a chart review linked to an existing ICN with a PWK01 = 09 and PWK02 = AA. Submit the chart review with a minimum of four (4) diagnosis codes for testing. The 999A and 277CA Reports are returned within 24 hours of submission. Validation on the file for a unique encounter is based on the following data fields: o Beneficiary HICN o Beneficiary Last Name o Date of Service o Place of Service o Type of Service o Procedure Code (and 4 modifiers) o Rendering Provider NPI o Paid Amount Files pass duplicate validation, paid amount balancing and continue processing. ED Processing Status Report is returned with Accepted status within seven (7) business days of submission 22
23 Step # Action Expected Results/ Evaluation Criteria Any errors found on the file will generate the ED Processing Status Report with a Rejected status within seven (7) business days of submission Assumptions and Constraints An existing ICN must be linked to the chart review submission. 23
24 3.8 TC08-Chart Review Unlinked Purpose The purpose of TC08-Chart Review-Unlinked Submission is to ensure supplemental chart review information without an associated encounter is captured in EODS for editing, processing, and appropriate pricing of submissions Prerequisite Conditions 1. System will accept 5010 version X12 standards for HIPAA transactions. 2. At least two (2) encounters are submitted for each type of test case scenario. 3. Remember to include a valid Provider Tax ID and the Rendering Provider NPI number Test Procedure Table 8: Test Procedure Steps for TC08-Chart Review Unlinked Submission Step # Action Expected Results/ Evaluation Criteria 1. Submit a chart review with no link to an ICN with a PWK01 = 09 and PWK02 = AA. The 999A and 277CA Reports are returned within 24 hours of submission. Validation on the file for a unique encounter is based on the following data fields: o Beneficiary HICN o Beneficiary Last Name o Date of Service o Place of Service o Type of Service o Procedure Code (and 4 modifiers) o Rendering Provider NPI o Paid Amount Files pass duplicate validation, paid amount balancing and continue processing. ED Processing Status Report is returned with Accepted status within seven (7) business days of submission. Any errors found on the file will generate the ED Processing Status Report with a Rejected status within seven (7) business days of submission. The chart review with no linked ICN is processed 24
25 Step # Action Expected Results/ Evaluation Criteria through the EDPS. Encounter data is checked against processing edits Assumptions and Constraints There can be no existing ICN linked to the submission of a chart review unlinked, and the data will not be priced in EDPS. 25
26 3.9 TC09-Duplicate Purpose The purpose of TC09-Duplicate Submission is to ensure information is not duplicated and stored for pricing and risk adjustment in EODS Prerequisite Conditions 1. System will accept 5010 version X12 standards for HIPAA transactions. 2. At least two (2) encounters are submitted for each type of test case scenario. 3. An original submission should be Accepted in EDPS prior to submitting a duplicate encounter submission. 4. Ensure that the interchange date and time (ISA09 and ISA10) are unique in the ISA-IEA interchange header file Test Procedure Table 9: Test Procedure Steps for TC09-Duplicate Submission Step # Action Expected Results/ Evaluation Criteria 1. Submit a duplicate 837-P encounter to the EDFES with duplicate data in all of the following fields: Beneficiary HICN Beneficiary Last Name Date of Service Place of Service Type of Service Procedure Code (and 4 modifiers) Rendering Provider NPI Paid Amount The 999A and 277CA Reports are returned within 24 hours of submission. Validation on the file for a unique encounter is based on the following data fields: o Beneficiary HICN o Beneficiary Last Name o Date of Service o Place of Service o Type of Service o Procedure Code (and 4 modifiers) o Rendering Provider NPI o Paid Amount The file is rejected due to duplicate data contained in EODS. ED Duplicates Report is generated and returned within seven (7) business days of submission. Any errors found on the file will generate the ED Processing Status Report with a Rejected status 26
27 Step # Action Expected Results/ Evaluation Criteria within seven (7) business days of submission Assumptions and Constraints It is assumed that the submission matches an existing encounter in the system. 27
28 3.10 TC10-Paper Generated Purpose The purpose of TC10-Paper Generated submissions is to test editing, processing, and appropriate pricing of submissions Prerequisite Conditions 1. System will accept 5010 version X12 standards for HIPAA transactions. 2. At least two (2) encounters are submitted for each type of test case scenario Test Procedure Table 10: Test Procedure Steps for TC10-Paper Generated Step # Action Expected Results/ Evaluation Criteria 1. Submit a paper claim encounter with required minimum data elements, including PWK01 = OZ and PWK02 = AA. The 999A and 277CA Reports are returned within 24 hours of submission. Validation on the file for a unique encounter is based on the following data fields: o Beneficiary HICN o Beneficiary Last Name o Date of Service o Place of Service o Type of Service o Procedure Code (and 4 modifiers) o Rendering Provider NPI o Paid Amount Files pass duplicate validation, paid amount balancing and continue processing. ED Processing Status Report is returned with Accepted status within seven (7) business days of submission. Any errors found on the file will generate the ED Processing Status Report with a Rejected status within seven (7) business days of submission 28
29 Assumptions and Constraints Provider NPIs should be submitted as appropriate, however if an NPI does not exist, PACE organizations may submit encounters using the default NPI =
30 3.11 TC11-Zip Code Purpose The purpose of TC11-Zip Code + 4 Submission is to test editing, processing, and appropriate pricing of submissions Prerequisite Conditions 1. System will accept 5010 version X12 standards for HIPAA transactions. 2. At least two (2) encounters are submitted for each type of test case scenario Test Procedure Table 11: Test Procedure Steps for TC11- Zip Code + 4 Submissions Step # Action Expected Results/ Evaluation Criteria 1. Submit an encounter with the zip code + 4 postal box identifier. Use 9999 as a default for the last four (4) digits of the zip code for one submission to test the case where this information does not exist on the original submission file. The 999A and 277CA Reports are returned within 24 hours of submission. Validation on the file for a unique encounter is based on the following data fields: o Beneficiary HICN o Beneficiary Last Name o Date of Service o Place of Service o Type of Service o Procedure Code (and 4 modifiers) o Rendering Provider NPI o Paid Amount Files pass duplicate validation, paid amount balancing and continue processing. ED Processing Status Report is returned with Accepted status within seven (7) business days of submission. Any errors found on the file will generate the ED Processing Status Report with a Rejected status within seven (7) business days of submission. 30
31 Assumptions and Constraints It is assumed that all encounter submissions will include submitter names. 31
32 3.12 TC12-Diagnoses Included in Model Diagnosis Codes Purpose The purpose of TC12-Diagnoses Included in Model Diagnosis Codes Submission is to test editing, processing, and appropriate pricing of submissions Prerequisite Conditions 1. System will accept 5010 version X12 standards for HIPAA transactions. 2. At least two (2) encounters are submitted for each type of test case scenario Test Procedure Table 12: Test Procedure Steps for TC12-Diagnoses Included in Model Diagnosis Codes Submission Step # Action Expected Results/ Evaluation Criteria 1. Submit a standard encounter with four (4) diagnoses from the model diagnoses spreadsheet, found at the following: Plans/MedicareAdvtgSpecRateStats/Risk_adj ustment.html The 999A and 277CA Reports are returned within 24 hours of submission. Validation on the file for a unique encounter is based on the following data fields: o Beneficiary HICN o Beneficiary Last Name o Date of Service o Place of Service o Type of Service o Procedure Code (and 4 modifiers) o Rendering Provider NPI o Paid Amount Files pass duplicate validation, paid amount balancing and continue processing. ED Processing Status Report is returned with Accepted status within seven (7) business days of submission. Any errors found on the file will generate the ED Processing Status Report with a Rejected status within seven (7) business days of submission. 32
33 Assumptions and Constraints It is assumed that MAOs have access to the CMS website where diagnoses models for risk adjustment are available for reference. There are no constraints identified for the submission of original encounter data. 33
34 CMS EDFESC EDFES EDIPPS EODS EDPPPS EDDPPS EDPS EDPSC EDS MA MAO Centers for Medicare & Medicaid Services Encounter Data Front End System Contractor Encounter Data Front End System Encounter Data Institutional Pricing and Processing System Encounter Data Operational Data Store Encounter Data Professional Pricing and Processing System Encounter Data DME Pricing and Processing System Encounter Data Processing System Encounter Data Processing System Contractor Encounter Data System Medicare Advantage Medicare Advantage Organization 34
Encounter Data System End-to-End Test Plan
Encounter Data System End-to-End Test Plan Encounter Data End-to-End Test Plan related to the Professional 837 Health Care Claim Transactions End-to-End Test Plan 1.0 1 Preface The Encounter Data System
Encounter Data System
System Industry February 2, 2012 1 Introduction Session Guidelines CMS Agenda o Testing Timeline o EDFES Certification Status Test Cases Review Reports o EDFES 277CA o EDPS MAO-002 Flat File and Formatted
Encounter Data System User Group. March 7, 2013
Encounter Data System User Group March 7, 2013 1 Agenda Purpose Session Guidelines CMS Updates EDS Updates EDS Known Issues EDS Edits Proxy Data Reason Codes EDS Operational Highlight Encounter Adjustments
Risk Adjustment for EDS & RAPS Webinar Q&A Documentation
Risk Adjustment for EDS & RAPS Webinar Q&A Documentation 11:00 a.m. 12:00 p.m. EDS Duplicate Logic Q1. Will CMS consider validation of diagnosis codes for the EDS duplicate logic? A1. At this time, CMS
Version 5010 Errata Provider Handout
Version 5010 Errata Provider Handout 5010 Bringing Clarity & Consistency To Your Electronic Transactions Benefits Transactions Impacted Changes Impacting Providers While we have highlighted the HIPAA Version
Best Practice Recommendation for
Best Practice Recommendation for Submitting & Processing Claims (5010 version) WorkSMART A program of the Washington Healthcare Forum operated by OneHealthPort 1 For use with ASC X12N 837 (005010X222)
Encounter Data User Group
Encounter Data User Group June 26, 2014 3:00 PM 4:00 PM ET 1 Agenda Purpose Session Guidelines CMS Updates System Enhancements EDS Operational Highlights Questions Submitted to ED Inbox EDS Industry Updates
National Meeting. Opening Remarks. Click to edit Master title style INDUSTRY OUTREACH
National Meeting Click to edit Master title style Opening Remarks Friday, October 29, 2010 CMS Auditorium Baltimore, MD INDUSTRY OUTREACH National Meeting Purpose October 29, 2010 CMS Headquarters Baltimore,
Medicare-Medicaid Plans (MMPs) An Introduction to Medicare-Medicaid Plan Encounter Data Submission Requirements
Medicare-Medicaid Plans (MMPs) An Introduction to Medicare-Medicaid Plan Encounter Data Submission Requirements AGENDA Overview Enrollment Process Connectivity Testing/Certification Companion Guides Data
Kentucky HIPAA HEALTH CARE CLAIM: INSTITUTIONAL Companion Guide 837
Kentucky HIPAA HEALTH CARE CLAIM: INSTITUTIONAL Companion 837 Version 1.4 Final RECORD OF CHANGE VERSION NUMBER DATE REVISED DESCRIPTION OF CHANGE PERSONS INVOLVED 1.0 10/25/02 Creation and first view
Medicare Encounter Data System
Medicare Encounter Data System Standard Companion Guide Transaction Information Instructions related to the 837 Health Care Claim: Institutional Transaction based on ASC X12 Technical Report Type 3 (TR3),
Medicare-Medicaid Plans (MMPs) An Introduction to Medicare-Medicaid Plan Encounter Data Submission Requirements
Medicare-Medicaid Plans (MMPs) An Introduction to Medicare-Medicaid Plan Encounter Data Submission Requirements AGENDA Overview Enrollment Process Connectivity Testing/Certification Companion Guides Data
278 Health Care Services Review - Request for Review and Response Companion Guide
278 Health Care Services Review - Request for Review and Response Companion Guide Version 1.1 August 7, 2006 Page 1 Version 1.1 August 7, 2006 TABLE OF CONTENTS INTRODUCTION 4 PURPOSE 4 SPECIAL CONSIDERATIONS
Health Care Service: Data Reporting (837)
X12 Standards for Electronic Data Interchange Technical Report Type 3 Health Care Service: Data Reporting (837) Change Log : 005010-007030 FEBRUARY 2017 Intellectual Property X12 holds the copyright on
276/277 Health Care Claim Status Request and Response
276/277 Health Care Claim Status Request and Response Companion Guide Version 1.1 Page 1 Version 1.1 August 4, 2006 TABLE OF CONTENTS INTRODUCTION 4 PURPOSE 4 SPECIAL CONSIDERATIONS 5 Inbound Transactions
837 Professional Health Care Claim
837 Professional Health Care Claim Overview 1 Claims Processing 1 Acknowledgements 1 Ancillary Billing 1 Anesthesia Billing 2 Coordination of Benefits (COB) Processing 2 Code Sets 2 Corrections and Reversals
HIPAA 5010 Transition Frequently Asked Questions/General Information
* Effective July 20, 2011, the HIPAA 5010 FAQ document has been updated and those questions are red bold and italicized for distinction. Q: What is HIPAA 5010? General HIPAA 5010 Questions A. In January
04/03/03 Health Care Claim: Institutional - 837
837 Health Care Claim: Institutional Companion Guide LA Medicaid HIPAA/V4010X096A1/837: 837 Health Care Claim: Institutional Version: 1.3 Update 06/08/04 Author: Publication: EDI Department LA Medicaid
Texas Medicaid. HIPAA Transaction Standard Companion Guide
Texas Medicaid HIPAA Transaction Standard Companion Guide Refers to the Implementation Guide Long Term Care 837 Health Care Claim: Professional Based on ASC X12 version 005010 CORE v5010 Companion Guide
06/21/04 Health Care Claim: Institutional - 837
837 Health Care Claim: Institutional Companion Guide LA Medicaid HIPAA/V4010X096A1/837: 837 Health Care Claim: Institutional Version: 1.5 Update 01/20/05 LTC/Hospice Room and Board/ICFMR/ADHC Author: Publication:
A Revenue Cycle Process Approach
A Revenue Cycle Process Approach VALERIUS BAYES NEWBY Education BLOCHOWIAK Preface x Parti Chapter1 WORKING WITH MEDICAL INSURANCE AND BILLING Chapter 3 Introduction to the Revenue Cycle 2 1.1 Working
WellCare FL_ Encounters. Florida 2016 Module 2: AHCA Rules and Guidelines
WellCare 2016. FL_061516. Encounters Florida 2016 Module 2: AHCA Rules and Guidelines Provider Validation and Registration Medicaid ID Registration Process 2 National Provider Identifier (NPI) & Medicaid
GUIDE TO BILLING HEALTH HOME CLAIMS
GUIDE TO BILLING HEALTH HOME CLAIMS 1 GUIDE TO BILLING HEALTH HOME CLAIMS DEFINITIONS...1 BILLING TIPS...2 EDI TRANSACTIONS GUIDE...5 ATTACHMENT A SERVICE GRID...6 ATTACHMENT B FEE SCHEDULE...8 EXHIBIT
837 Health Care Claim: Institutional LTC - Hospice Room and Board ICFDD ADHC*
837 Health Care Claim: Institutional LTC - Hospice Room and Board ICFDD ADHC* HIPAA/V5010X223A2/837: Health Care Claim Institutional, Louisiana edicaid Version: 1.4 Created: 10/25/2011 Revised: 5/18/2016
The Transition to Version 5010 and ICD-10
The Transition to Version 5010 and ICD-10 An Overview Denise M. Buenning, MsM Director, Administrative Simplification Group Office of E-Health Standards and Services Centers for Medicare & Medicaid Services
Version Number: 1.0 Introduction Matrix. November 01, 2011
Wellmark Blue Cross and Blue Shield HIPAA Transaction Standard Companion Guide Section 2, 837 Professional Refers to the X12N Technical Report Type 3 ANSI Version 5010A1 Version Number: 1.0 Introduction
July Subject: Changes for the Institutional 837 and 835 Companion Document. Dear software developer,
July 2012 Subject: Changes for the Institutional 837 and 835 Companion Document Dear software developer, A revised, updated copy of the ANSI ASC X12N 837 & 835 Institutional Health Care Claim & Health
CLINIC. [Type text] [Type text] [Type text] Version
New York State Billing Guidelines [Type text] [Type text] [Type text] Version 2013-01 6/28/2013 EMEDNY INFORMATION emedny is the name of the electronic New York State Medicaid system. The emedny system
Encounter Submission Guide
Encounter Submission Guide Page 1 of 6 Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield independent
Audio Title: Revised and Clarified Place of Service (POS) Coding Instructions Audio Date: 6/3/2015 Run Time: 16:03 Minutes ICN:
Audio Title: Revised and Clarified Place of Service (POS) Coding Instructions Audio Date: 6/3/2015 Run Time: 16:03 Minutes ICN: 909207 Welcome to Medicare Learning Network Podcasts at the Centers for Medicare
National Association for Home Care & Hospice
National Association for Home Care & Hospice How to Stay Informed: Updates from Palmetto GBA Part I Presented by Charles Canaan Top Reasons for HH Denials 1 56900 Auto Denial - Requested Records not Submitted
Outpatient Hospital Facilities
Outpatient Hospital Facilities Chapter 6 Chapter Outline Introduce students to 1. Different outpatient facilities 2. Different departments involved in the reimbursement process 3. The Chargemaster 4. Terminology
TCS FAQ s. How will the implementation of national standard code sets reduce burden on the health care industry?
TCS FAQ s What is a code set? Under HIPAA, a code set is any set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnosis codes, or medical procedure codes.
Required Data for Claim Forms (CMS-1500 & UB-04) Claim Submission Instructions (MLTC) Care Healthcare and VNSNY CHOICE Transition
2018 Provider Manual VNSNY CHOICE Appendix V Claims CMS-1500 Form (Sample) UB-04 Form (Sample) Required Data for Claim Forms (CMS-1500 & UB-04) Claim Submission Instructions (MLTC) ICD-10 FAQ Care Healthcare
A. Encounter Data Submission Requirements
A. Encounter Data Submission Requirements APPLIES TO: A. This policy applies to all IEHP Medi-Cal Providers. POLICY: A. As of October 1, 2015, IEHP has transitioned to ICD-10 diagnosis and procedure coding
AMBULATORY SURGICAL CENTERS PROVIDER MANUAL Chapter Twenty-nine of the Medicaid Services Manual
AMBULATORY SURGICAL CENTERS PROVIDER MANUAL Chapter Twenty-nine of the Medicaid Services Manual Issued November 1, 2010 Claims/authorizations for dates of service on or after October 1, 2015 must use the
Medicare Claims Processing Manual Chapter 11 - Processing Hospice Claims
Medicare Claims Processing Manual Chapter 11 - Processing Hospice Claims Transmittals for Chapter 11 Table of Contents (Rev. 3326, 08-14-15) (Rev. 3378, 10-16-15) 10 - Overview 10.1 - Hospice Pre-Election
Connecticut Medical Assistance Program. Hospice Refresher Workshop
Connecticut Medical Assistance Program Hospice Refresher Workshop Training Topics What s New in 2015? Electronic Messaging Claim Adjustments Messages Archived Proposed Changes in Hospice Rates Fiscal Year
Hospital Refresher Workshop. Presented by The Department of Social Services & HP Enterprise Services
Hospital Refresher Workshop Presented by The Department of Social Services & HP Enterprise Services 1 Training Topics Provider Bulletins Outpatient Claim Billing Changes Explanation of Benefit Codes Web
Health Care Services Review Request for Review and Response to Request for Review
PacifiCare Electronic Data Interchange 278 Transaction Companion Guide Health Care Services Review Request for Review and Response to Request for Review (Version1.0 October 2003) 278 ANSI ASC X12 278 (004010X094
Home and Community- Based Services Waiver Program. HP Provider Relations/October 2014
Home and Community- Based Services Waiver Program HP Provider Relations/October 2014 Agenda Objectives Overview of the Home and Community- Based Services (HCBS) Waiver Program Member eligibility Billing
CMS-1500 Billing and Reimbursement. HP Provider Relations/October 2013
CMS-1500 Billing and Reimbursement HP Provider Relations/October 2013 Agenda Common Denials for CMS-1500 CMS-1500 Claims Billing Types of CMS-1500 Claims Paper Claim Billing Fee Schedule Crossover Claims
UPDATED Nursing/Intermediate Care Facility Providers
December 2008 Provider Bulletin Number 8160 UPDATED Nursing/Intermediate Care Facility Providers Revenue Codes The revenue codes listed under field 42 for the UB-04 form were inadvertently deleted with
Tips for Completing the UB04 (CMS-1450) Claim Form
Tips for Completing the UB04 (CMS-1450) Claim Form As a Beacon facility partner, we value the services you provide and it is important to us that you are reimbursed for the work you do. To assure your
HIPAA 5010 Transition Frequently Asked Questions/General Information
The HIPAA 5010 FAQ document will continue to be updated frequently in order to provide the most current and pertinent information. Please check the HIPAA 5010 FAQ document on a regular basis for additional
Connecticut Medical Assistance Program Refresher for Hospice Providers. Presented by The Department of Social Services & HP for Billing Providers
Connecticut Medical Assistance Program Refresher for Hospice Providers Presented by The Department of Social Services & HP for Billing Providers 1 Training Topics Hospice Agenda HIPAA 5010 Hospice Form
Connecticut Medical Assistance Program Refresher for Hospice Providers. Presented by The Department of Social Services & HP for Billing Providers
Connecticut Medical Assistance Program Refresher for Hospice Providers Presented by The Department of Social Services & HP for Billing Providers 1 Hospice Agenda Overview Forms Fee Schedule/Reimbursement
OptumHealth Operations Guide
OptumHealth Operations Guide Kidney Resource Services Table of Contents Operations Guide Overview...3 KIDNEY RESOURCE SERVICES PROGRAM OVERVIEW...3 HEALTH CARE PROVIDER ON-BOARDING PROCESS...3 CLINICAL
Medicaid Claims Handling for Medicaid Members
Medicaid Claims Handling for Medicaid Members Blue Cross and Blue Shield (BCBS) Plans currently administer Medicaid programs in California, Delaware, Hawaii, Illinois, Indiana, Kentucky, Michigan, Minnesota,
Chapter 9 Section 1. Ambulatory Surgical Center (ASC) Reimbursement
Ambulatory Surgery Centers (ASCs) Chapter 9 Section 1 Issue Date: August 26, 1985 Authority: 32 CFR 199.14(d) Copyright: CPT only 2006 American Medical Association (or such other date of publication of
MassHealth Provider Billing and Services Updates & Upcoming Initiatives. Massachusetts Health Care Training Forum July 2011
MassHealth Provider Billing and Services Updates & Upcoming Initiatives Massachusetts Health Care Training Forum July 2011 Agenda I. MassHealth Updates/Resources & Upcoming MassHealth Initiatives II. Paper
Modifiers 80, 81, 82, and AS - Assistant At Surgery
Manual: Policy Title: Reimbursement Policy Modifiers 80, 81, 82, and AS - Assistant At Surgery Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM013 Last Updated: 7/11/2017
UB-04 Claim Form Instructions
UB-04 Claim Form This document explains the UB-04 claim form, which is used for submitting claims for reimbursement for specially designated facilities. The instructions included in this section are excerpts
Attachments 101. Using Attachments with Health Care Claims Health Care Encounters Health Care Services Review
Attachments 101 Using Attachments with Health Care Claims Health Care Encounters Health Care Services Review DISCLAIMER This presentation is for informational purposes only The content is point-in-time
CAHPS Hospice Survey Podcast for Hospices Transcript Data Hospices Must Provide to their Survey Vendor
CAHPS Hospice Survey Data Hospices Must Provide to their Survey Vendor Presentation available at: Slide 1 Welcome to the CAHPS Hospice Survey: Podcast for Hospices series. These podcasts were created for
HOW TO SUBMIT OWCP-04 BILLS TO ACS
HOW TO SUBMIT OWCP-04 BILLS TO ACS The following services should be billed on the OWCP-04 Form: General Hospital Hospice Nursing Home Rehabilitation Centers As a provider you have the option of sending
Shared and Incident To Billing of E/M Services in Radiation Oncology Updated November 2017
ASTRO Guidance on Shared and Incident To Billing of Evaluation and Management Services in Radiation Oncology The Centers for Medicare and Medicaid Services (CMS) establishes Medicare policy for the payment
CONTRACT YEAR 2011 MEDICARE ADVANTAGE PRIVATE FEE-FOR-SERVICE PLAN MODEL TERMS AND CONDITIONS OF PAYMENT
CONTRACT YEAR 2011 MEDICARE ADVANTAGE PRIVATE FEE-FOR-SERVICE PLAN MODEL TERMS AND CONDITIONS OF PAYMENT Table of Contents 1. Introduction 2. When a provider is deemed to accept Flexi Blue PFFS terms and
Chapter 9 Section 1. Ambulatory Surgical Center (ASC) Reimbursement
Ambulatory Surgery Centers (ASCs) Chapter 9 Section 1 Issue Date: August 26, 1985 Authority: 32 CFR 199.14(d) Copyright: CPT only 2006 American Medical Association (or such other date of publication of
Reimbursement Information for Contrast Enhanced Spectral Mammography (CESM) Services 1
GE Healthcare Reimbursement Information for Contrast Enhanced Spectral Mammography (CESM) Services 1 May 2018 www.gehealthcare.com/reimbursement This advisory addresses Medicare coding, coverage and payment
Payment Policy: High Complexity Medical Decision-Making Reference Number: CC.PP.051 Product Types: ALL
Payment Policy: High Complexity Medical Decision-Making Reference Number: CC.PP.051 Product Types: ALL Effective Date: 6/2017 Last Review Date: See Important Reminder at the end of this policy for important
INDEPENDENT VERIFICATION AND CODING VALIDATION (IV & V) FOR APR-DRG. Effective September 1, 2014
INDEPENDENT VERIFICATION AND CODING VALIDATION (IV & V) FOR APR-DRG Effective September 1, 2014 Who are we? eqhealth has a 16 year partnership with Mississippi Division of Medicaid (DOM) as the Utilization
Care360 EHR Frequently Asked Questions
Care360 EHR Frequently Asked Questions Table of Contents Care360 EHR... 4 What is Care360 EHR?... 4 What are the current capabilities of Care 360 EHR?... 4 Is Care 360 EHR an EMR?... 5 Can I have Care360
National Provider Identifier Fact Book for State Sponsored Business
National Provider Identifier Fact Book for State Sponsored Business Contents Contact Information... 1 NPI 101 Frequently Asked Questions... 2 Provider Checklist... 5 How to Submit Your NPI on Electronic
Coding Guidelines for Certain Respiratory Care Services January 2018 (updates in red)
Coding Guidelines for Certain Respiratory Care Services (updates in red) Overview From time to time the AARC receives inquiries about respiratory-related coding and coverage issues through its Help Line
Superior HealthPlan STAR+PLUS
Superior HealthPlan STAR+PLUS Provider Training (non-nursing Facility Residents) SHP_2015883 Who is Superior HealthPlan? Superior HealthPlan is a subsidiary of Centene Corporation located in St. Louis,
2018 Northern California HMO Provider Manual Kaiser Foundation Health Plan, Inc.
2018 Northern California HMO Provider Manual Kaiser Foundation Health Plan, Inc. Welcome from Kaiser Permanente It is our pleasure to welcome you as a contracted provider (Provider) participating under
Standard Companion Guide. ASC X12N 270/271: Health Care Eligibility Benefit Inquiry and Response CORE Phase II System Companion Guide
Standard Companion Guide ASC X12N 270/271: Health Care Eligibility Benefit Inquiry and Response CORE Phase II System Companion Guide Version : 1.0 February 2012 Page 1 of 33 Disclosure Statement The information
Highmark West Virginia
Highmark West Virginia HIPAA Transaction Standard Companion Guide Refers to the Implementation Guides Based on ASC X12 Implementation Guides, version 005010 July 2014 July 2014 005010 1 Preface This Companion
Illinois Medicaid EHR Incentive Program for EPs
The Chicago HIT Regional Extension Center Bringing Chicago together through health IT < INSERT PICTURE > Illinois Medicaid EHR Incentive Program for EPs A Guide to Attesting for the 2016 Program Year in
CMS Meaningful Use Incentives NPRM
CMS Meaningful Use Incentives NPRM Margret Amatayakul MBA, RHIA, CHPS, CPHIT, CPEHR, CPHIE, FHIMSS President, Margret\A Consulting, LLC Faculty and Board of Examiners, Health IT Certification, LLC Notice
NHPCO Regulatory Recap for Activity from August 2011 Volume 1, Issue No.8
NHPCO Regulatory Recap for Activity from August 2011 Volume 1, Issue No.8 To: NHPCO Membership From: NHPCO Regulatory Team IN THIS ISSUE: CMS Help Prevent Fraud Campaign CMS Provider Compliance Group Outreach
UB-92 Billing Instructions
August 26, 2005 UB-92 Billing Instructions 2005 Hospital Provider Workshop Conduent MS Medicaid Project Government Healthcare Solutions Objective & Definition To explain how to complete a UB-92 claim form
Subject: Updated UB-04 Paper Claim Form Requirements
INDIANA HEALTH COVERAGE PROGRAMS P R O V I D E R B U L L E T I N B T 2 0 0 7 0 2 J A N U A R Y 3 0, 2 0 0 7 To: All Providers Subject: Updated UB-04 Paper Claim Form Requirements Overview The following
CareFirst ICD-10 Claim Submission Guidelines
CareFirst ICD-10 Claim Submission Guidelines Introduction The U.S. Department of Health and Human (HHS) has released a HIPAA administration simplification mandate requiring all HIPAA entities to adopt
MLN Matters Number: MM6740 Revised Related Change Request (CR) #: Related CR Transmittal #: R1875CP Implementation Date: January 4, 2010
News Flash Flu Season is upon us! CMS encourages providers to begin taking advantage of each office visit to encourage your patients with Medicare to get a seasonal flu shot; it s their best defense against
Billing & Reimbursement Presentation. November 28, 2007
Billing & Reimbursement Presentation November 28, 2007 Billing & Reimbursement for Joslin Affiliates Introduce yourself - front end clinic & operations staff need to meet hospital chargemaster, coding
FREQUENTLY ASKED QUESTIONS FOR HOSPITALS AND ASCS OAS CAHPS
FREQUENTLY ASKED QUESTIONS FOR HOSPITALS AND ASCS OAS CAHPS How do I know if my hospital or ASC is eligible to participate in the OAS CAHPS Survey? An eligible hospital has an outpatient surgery department
Compliant Documentation for Coding and Billing. Caren Swartz CPC,CPMA,CPC-H,CPC-I
Compliant Documentation for Coding and Billing Caren Swartz CPC,CPMA,CPC-H,CPC-I caren@practiceintegrity.com Disclaimer Information contained in this text is based on CPT, ICD-9-CM and HCPCS rules and
Tips for Completing the CMS-1500 Version 02/12 Claim Form
Tips for Completing the CMS-1500 Version 02/12 Claim Form NOTE: FAILURE TO PROVIDE VALID INFORMATION MATCHING THE INSURED S ID CARD COULD RESULT IN A REJECTION OF YOUR CLAIM. Enter in the white, open carrier
Change Healthcare ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account
PAYER ID: SUBMITTER ID: 1 Provider Organization Practice/ Facility Name Change Healthcare ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account Provider Name
Medicaid EHR Incentive Program Health Information Exchange Objective Stage 3 Updated: February 2017
Medicaid EHR Incentive Program Health Information Exchange Objective Stage 3 Updated: February 2017 The Health Information Exchange (HIE) objective (formerly known as Summary of Care ) is required for
TES Charge Entry with Patient Name
TES Charge Entry with Patient Name Overview Introduction After a visit is created, you can enter a charge using the patient s name. It is often easier to enter charges using an appointment number or a
Senior Whole Health Frequently Asked Questions
Senior Whole Health Frequently Asked Questions Q. What states are included in Senior Whole Health? A. ValueOptions is now managing the behavioral health benefits for Senior Whole Health members in the
Diagnosis Code Requirements - Invalid As Primary
Manual: Policy Title: Reimbursement Policy Diagnosis Code Requirements - Invalid As Primary Section: Administrative Subsection: Diagnosis Codes Date of Origin: 1/1/2000 Policy Number: RPM054 Last Updated:
AMBULATORY SURGICAL CENTER QUALITY REPORTING (ASCQR) PROGRAM REFERENCE CHECKLIST
AMBULATORY SURGICAL CENTER QUALITY REPORTING (ASCQR) PROGRAM REFERENCE CHECKLIST ASCQR PROGRAM REQUIREMENTS SUMMARY This document outlines the requirements for ASCs, paid by Medicare under Part B Fee-for-
LABORATORY. [Type text] [Type text] [Type text] Version
New York State 150003 Billing Guidelines [Type text] [Type text] [Type text] Version 2011-01 6/1/2011 EMEDNY INFORMATION emedny is the name of the electronic New York State Medicaid system. The emedny
The presenter has owns Kelly Willenberg, LLC in relation to this educational activity.
Kelly M Willenberg, MBA, BSN, CCRP, CHC, CHRC 1 The presenter has owns Kelly Willenberg, LLC in relation to this educational activity. 2 1 Medical Necessity when you submit claims Coding for qualifying
Jaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC Disclaimer
Advanced Evaluation and Management More than a roll of the dice? History Exam Medical Decision Making Jaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC jaci@practieintegrity.com
(EHR) Incentive Program
REGISTRATION USER GUIDE For Eligible Professionals Medicare Electronic Health Record (EHR) Incentive Program DECEMBER 2010 (12.28.10 ver2) CONTENTS Step 1... Getting started 3 Step 2... Login instruction
All Medicare Advantage Organizations (MAOs), PACE Organizations, Cost Plans, and certain Demonstrations
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE MEDICARE PLAN PAYMENT GROUP TO: FROM: SUBJECT:
Rural Health Clinic Overview
TrailBlazer Health Enterprises Rural Health Clinic Overview Steven W. Mildward Published March 2012 108724 2012 TrailBlazer Health Enterprises /TrailBlazer. All rights reserved. Important The information
ARKANSAS HEALTHCARE TRANSPARENCY INITIATIVE: DATA SUBMISSION GUIDE & ONBOARDING FREQUENTLY ASKED QUESTIONS
ARKANSAS HEALTHCARE TRANSPARENCY INITIATIVE: DATA SUBMISSION GUIDE & ONBOARDING FREQUENTLY ASKED QUESTIONS December 2015 Kenley Money, APCD Director Sheila Dodson, APCD Technical Support Version: 4.1.2015
Hospital-Based Ambulatory Care
C H A P T E R 2 Hospital-Based Ambulatory Care ANSWERS TO KNOWLEDGE-BASED QUESTIONS 1. What has been the trend in the utilization of hospital-based services? What factors help to account for this trend?
All Medicare Advantage Organizations (MAOs), PACE Organizations, Cost Plans, and certain Demonstrations
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE MEDICARE PLAN PAYMENT GROUP TO: FROM: SUBJECT:
Getting Connected To ValueOptions
ValueOptions of Kansas And The Kansas Department of Social and Rehabilitation Services Present Getting Connected To ValueOptions June 14, 2007 National Network Operations Your voice at ValueOptions Network
Important RMHP Pharmacy Change for 2016
Fall 2015 Provider Edition Important RMHP Pharmacy Change for 2016 In an effort to control increasing medication costs, RMHP will begin using MedImpact s High Performance pharmacy network beginning January
Texas Medicaid. HIPAA Transaction Standard Companion Guide
Texas Medicaid HIPAA Transaction Standard Companion Guide Refers to the Implementation Guide - 278 Health Care Services Review Request and Response- Authorization Request for PASRR Nursing Facility Specialized
Medicare Claims Processing Manual Chapter 26 - Completing and Processing Form CMS-1500 Data Set
Medicare Claims Processing Manual Chapter 26 - Completing and Processing Form CMS-1500 Data Set Transmittals for Chapter 26 Crosswalk to Old Manuals Table of Contents (Rev. 2204, 04-29-11) 10 - Health
Neighborhood Health Plan
Neighborhood Health Plan HIPAA Transaction Standard Companion Guide (270/271, 005010X279A1) Refers to the Technical Report Type 3 based on X12 version 005010A1 Companion Guide Version Number 1.0 1 Contents