DDE: I tried to access my claim through the FISS/DDE system and it will not let me pull it up. What is the problem?

DDE: I have a claim which was fully denied and I am attempting to use the automated denial adjustment process, but the FISS/DDE system is not allowing me to adjust my claim. Why am I not able to bring up my claim and submit the adjustment?

DDE: My name changed and I need to change the name associated to my log on ID. How do I do that?

DDE: How do I get my log on ID password reset?

DDE: Can a provider view additional development requests (ADRs) via the FISS/DDE?

CLAIMS: I received a denial stating that the documentation submitted did not support the medical necessity of laboratory services. Can you tell me what I can submit to support these services?

CLAIMS: How do I indicate on a Medicare claim that the services are NOT related to a liability, no fault (including medical payment) or Workers’ Compensation accident, injury or illness MSP record in the CWF?

Modifiers

Modifiers Table of Contents General Modifier Information CPT Modifiers (Used in Medicare Part B) HCPCS Modifiers ABN Modifiers GA, GX, GY and GZ Ambulance Origin and Destination Modifiers [Return to Top] General Modifier [...]

Modifier Usage

Modifier Usage Table of Contents E/M Services Within a Global Surgical Period – Modifiers 24, 25 and 57 24 – Unrelated E/M Service by the Same Physician During a Postoperative Period 25 – Significant, Separately Identifiable E/M [...]

Proper Use of Modifiers 59 and 91

Proper Use of Modifiers 59 and 91 Table of Contents Modifier 59 Appropriate Usage Inappropriate Usage Modifier 91 Appropriate Usage Inappropriate Usage Additional Information Related Content [Return to Top] [...]

Repeat Procedures - Modifiers 76 and 77

Repeat Procedures - Modifiers 76 and 77 Exact duplicate data fields submitted for claims include: Same beneficiary Same provider Same dates of service Same types of services Same place of service Same procedure codes Same billed [...]

Deceased Beneficiary Claims

Medicare Part B 101 Deceased Beneficiary Claims Table of Contents Deceased Beneficiary Claims Unpaid Bills Paid Bills Assigned Claims [Return to Top] Deceased Beneficiary Claims Medicare law outlining the payment of the medical [...]

Payment Floor Standards

Medicare Part B 101 Manual Payment Floor Standards The “payment floor” establishes a waiting period during which time the contractor may not pay, issue, mail or otherwise finalize the initial determination on a clean claim. The “payment [...]

Limiting Charge

Medicare Part B 101 Manual Limiting Charge Table of Contents Federal Limiting Charge Federal Limiting Charge for Medicare Secondary Payer [Return to Top] Federal Limiting Charge As part of the Omnibus Budget Reconciliation Act of [...]

Medigap

Medicare Part B 101 Manual Medigap Table of Contents Medigap Medigap Crossover Billing Procedures Item 13 Completion Requirement Automatic Crossover Medigap Versus Commercial Crossovers Medicaid Crossovers [Return to Top] [...]

Modifiers

Medicare Part B 101 Manual Modifiers What Is a Modifier? Modifiers are two-digit codes used to report additional information used during claims processing. Modifiers may be alpha-alpha, alphanumeric or numeric-numeric. Modifiers are used [...]

Nonphysician Practitioners

Medicare Part B 101 Manual Nonphysician Practitioners Table of Contents Nonphysician Practitioners Direct Billing/Payment for NPP Services Furnished to Inpatients and Outpatients Related Content [Return to Top] Nonphysician [...]

Standard Remittance ANSI Codes and Remittance Advice

Medicare Part B 101 Manual Standard Remittance ANSI Codes and Remittance Advice Table of Contents What Is a Remittance Advice? What are the Uses for a Remittance Advice? What are the Different Types of Remittance Advice? What You [...]

Appendix 1: Forms

Medicare Part B 101 Manual Appendix 1: Forms Appeals Coverage Customer Care Documentation EDI Enrollment Other Advance Payments CMS Forms Investigational Device Exemption Requests Medicare Privacy Statement Form Vaccine [...]

Appendix 2: Glossary

Medicare Part B 101 Manual Appendix 2: Glossary of Terms The Glossary of Terms listed below are in alphabetical order. Term Definition ABN Advance Beneficiary Notice: A formal notice of noncoverage that a [...]