Billing & Claim Forms

Billing & Claim Forms Medicare Authorization to Disclose Medicare Information Use this form to advise Medicare of the person or persons you have chosen to have access to your personal health information. Patient's Request for Medical [...]

Claim Data Entry

Chapter V: Claims/Attachments Submenu (02) Claim Data Entry Purpose The Claims Entry options allows the provider to enter claims and roster bills electronically into the FISS DDE Provider Online System. To initiate claim data entry [...]

FQHC and Group Therapy Services Job Aid

FQHC and Group Therapy Services Job Aid Historically, federally qualified health center’s (FQHC’s) billing instructions have been the same. However, effective 1/1/2011, the billing requirements changed for this facility type. Beginning with [...]

Revenue Codes (13)

Chapter IV: Inquiries Submenu (01) Revenue Codes (13) Purpose The purpose of the REVENUE CODES option is to provide access to details related to the revenue codes available to be reported on a claim. A revenue code is a four-digit number [...]

Determine if Medicare Will Make Payment on an MSP Claim

Table of Contents Determine if Medicare Will Make Payment on an MSP Claim Step 1: Determine if Medicare will Make an MSP Payment Step 2: Determine the Amount of Secondary Benefits Billing Reminders Which Can Affect your Medicare [...]

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Provider Based Determinations

Table of Contents Provider Based Determinations Processing of Provider-Based Determinations MAC Provider-Based Designation Checklist Related Content [Return to Top] Provider Based Determinations On 4/18/2003, CMS issued a Program [...]

FY 2025 Occ Mix Hospital Letter Final

FY 2025 Occ Mix Hospital Letter Final CY 2022 Medicare Occupational Mix Survey Submission Section 1886(d) (3) (E) of the Social Security Act requires CMS to collect data every three years on the occupational mix of employees for each [...]