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Posting Date: 11/08/2023
Set Up an Extended Repayment Schedule
If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted immediately. While you may request an ERS at any time during the debt-collection process, timely submission of a valid request [...]
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Posting Date: 11/08/2023
Set Up an Extended Repayment Schedule
If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted immediately. While you may request an ERS at any time during the debt-collection process, timely submission of a valid request [...]
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Posting Date: 11/08/2023
Provider Enrollment: Reminder for Open Enrollment and Participation Agreement
Provider Enrollment: Reminder for Open Enrollment and Participation Agreement The 2024 Annual Participation Open Enrollment Period is approaching for another year. While this is an important time (from mid-November to December 31) for [...]
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Posting Date: 09/16/2020
Provider Enrollment <6>
table, td, th table { border-collapse: collapse; width: 50%; } Provider Enrollment <6> When Provider Enrollment is selected, the IVR will request and collect the following information: Case number (If case number is unavailable, [...]
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Posting Date: 09/16/2020
Appeals <7>
table, td, th table { border-collapse: collapse; width: 50%; } Appeals <7> When the Appeals option is selected, the IVR will request and collect the following elements: Provider authentication elements: NPI PTAN TIN Note: [...]
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Posting Date: 09/16/2020
General Information <8>
table, td, th table { border-collapse: collapse; width: 50%; } General Information <8> When the general information option is selected, the IVR will prompt you to choose from the following options: Phone numbers Addresses [...]
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Posting Date: 09/16/2020
Phonetic Alphabet
table, td, th table { border-collapse: collapse; width: 50%; } Phonetic Alphabet To assist you when speaking terms that are alpha-numeric, we have implemented the phonetic alphabet. When speaking an alpha character, please use the either [...]
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Posting Date: 09/16/2020
Using Touch-Tone
Using Touch-Tone The IVR is programmed to allow for the entry of all data using touch‐tone in the event the user is unable to successfully speak to the IVR. These instructions detail how to use touch‐tone to enter various types of information [...]
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Posting Date: 09/16/2020
Checks <3>
table, td, th table { border-collapse: collapse; width: 50%; } Checks <3> If you are part of a group, remember to use the group NPI, PTAN and TIN for authentication purposes. Upon selecting Checks, the provider will need to [...]
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Posting Date: 09/16/2020
Remittance Statements <4>
table, td, th table { border-collapse: collapse; width: 50%; } Remittance Statements <4> Upon selecting Remittance Statements, the provider will need to authenticate the following information: NPI PTAN Last five (5) digits of [...]
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Posting Date: 09/16/2020
Patient Status <6>
table, td, th table { border-collapse: collapse; width: 50%; } Patient Status <6> When Patient Status is selected, the IVR will request and collect the following information: NPI PTAN TIN Once the authentication elements [...]
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Posting Date: 09/16/2020
Appeal Status <7>
Appeal Status <7> When Appeal Status is selected, the IVR will request and collect the following information: NPI PTAN TIN HICN or MBI Refer to the Phonetic Alphabet for assistance with speaking alpha characters [...]
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Posting Date: 11/08/2023
Determine Beneficiary Responsibility on an MSP Claim
Table of Contents Determine Beneficiary Responsibility on an MSP Claim Step 1: Review the Remittance Advice Step 2: Assess the Beneficiary’s Responsibility The MSP Patient Responsibility Formula: The Beneficiary’s Responsibility on [...]
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Posting Date: 11/09/2023
MLN Connects® Newsletter: November 9, 2023
MLN Connects® Newsletter: November 9, 2023 News CMS Roundup (Nov 3, 2023) Marriage and Family Therapists & Mental Health Counselors: Enroll in Medicare Now American Indians or Alaska Natives: Help Your Patients Achieve Optimal [...]
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Posting Date: 05/03/2022
Vein Ablation and Related Services
General Documentation Requirements for Vein Ablation and Related Services Checklist of prior authorization request (PAR) information to include: Doppler ultrasound results Documentation stating presence or absence of DVT (deep vein [...]
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Posting Date: 03/17/2016
Electrical Stimulation Therapy: Important Coverage and Documentation Reminders
Electrical Stimulation Therapy: Important Coverage and Documentation Reminders Table of Contents CPT/HCPCS: 97032 Coverage and Documentation Provider Actions Related Content [Return to Top] CPT/HCPCS: 97032 National Government [...]
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Posting Date: 02/26/2016
Documentation Reminder: Psychiatry and Psychology Services
Documentation Reminder: Psychiatry and Psychology Services Table of Contents Documentation Reminder: Psychiatry and Psychology Services Submitting Documentation Provider Actions Related Content [Return to Top] Documentation [...]
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Posting Date: 05/03/2022
Botulinum Toxin Injections
General Documentation Requirements for Botulinum Toxin Injections Prior authorization is only required when one of the required Botulinum Toxin codes (J0585, J0586, J0587, or J0588) is used in conjunction with one of the required CPT injection [...]
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Posting Date: 11/09/2023
Processing Issue Botulinum Toxin Claims Returned to Provider with 5PRIA
Part A claims that have been submitted with Botulinum J codes (J0585, J0586, J0587, J0588) have incorrectly RTP with reason code 5PRIA.
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Posting Date: 08/04/2022
Medicare Part B Coverage and Billing Guidance for Breast Ultrasound
Medicare Part B Coverage and Billing Guidance for Breast Ultrasound Breast ultrasound uses sound waves to produce pictures of the inside of the breast and can show changes that are more difficult to see on a mammogram. Breast ultrasound is not [...]
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