APPEALS: We are a large group with many physician and nonphysician practitioners. When we submit claims for nonphysician practitioners working in different sub-specialties, we receive denials that state: D984: Coverage/program guidelines not met, N20: Service not payable with other service rendered on the same day.

APPEALS: Is there a time limit for filing an appeal?

APPEALS: Is there a reference sheet to determine what constitutes an appeal?

APPEALS: We are a large group with many physicians and nonphysician practitioners. When we submit claims for nonphysician practitioners working in different sub-specialties, we get claim denials that state: “D463: New patient qualifications were not met or M13: Only one initial visit is covered per specialty per medical group.” How can we avoid these?

APPEALS: What is a Medicare appeal?

APPEALS: What is the appeal process?

APPEALS: What is the solution to avoiding claim denials?

APPEALS: What is the best way to get duplicate denials paid on appeal?

Understanding the Approval Recommendation Process for Certified Providers

Understanding the Approval Recommendation Process for Certified Providers The certified provider completes and submits a CMS-855 enrollment application and all supporting documentation to its MAC, including any state require documentation [...]

EDI: I received a payer acknowledgement/acceptance report from my clearinghouse. Does this mean you accepted my claims?

EDI: I heard that 5010 requires a physical address in box 33 and P.O. boxes are no longer accepted. Is this true?

EDI: I am receiving the following Claim Status Code and EIC code on my 277CA. What do these codes mean?

EDI: I received my application back with errors on my Provider Authorization Form. Can I correct it or will I have to complete an entirely new application and authorization form?

EDI: What is a Network Service Vendor (NSV)?

EDI: I am missing an Electronic Remittance Advice (ERA). How do I order a duplicate?

EDI: I am receiving the following CSC and EIC code on my 277CA. How do I make the correction?

EDI: What PTAN should I enter on the EDI enrollment forms if the provider is a member of a group?

EDI: What Entity Name should I enter on the EDI Enrollment Agreement form?

EDI: What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance?

EDI: Will you reject claims where the group number and policy number are the same values?