meridiantotal - quick billing guide · quick billing guide this guide explains how to submit a...
TRANSCRIPT
Quick Billing Guide This guide explains how to submit a claim to
MeridianTotal, identifies claim forms, and
provides tips to ensure you are following
HFS guidelines and processes.
Questions? Contact Us:
Provider Services: 877-941-0482
mmp.MeridianTotal.com
Claim Submission Process
MeridianTotal accepts CMS 1500 (Professional Claims), UB-04
(Institutional Claims), EDI and claims submitted on our Website Portal*
https://mmp.MeridianTotal.com/mmp/for-providers0/provider-login.html *You must request access to the secure site by registering for a user name/password and have
requested claims access. To obtain an ID, please contact Provider Services at 877-941-0482.
• Claims must be received by MeridianTotal no later than 180 days
from the date on which services or items are provided.
•
•
Requests for Reconsideration must be received within 90 days of the original determination or Explanation of Payment (EOP). Corrected claims must be submitted within 180 days of service or date of discharge, whichever is later.
Billing Do’s and Don’tsDO – •
•
•
•
•
•
•
•
Submit your claim within 180 days of the
DOS
Submit on a proper original form CMS
1500 in Red
Mail to the correct PO Box number
Submit all paper claims in a 9 x 12 or
larger envelope
Type all fields completely and accurately
Use type blue or black ink only in 9 pt
font
Include all other insurance information;
policy holder, carrier name, ID number,
address
Recheck all information before mailing
DON’T – •
•
•
•
Submit handwritten claims
Use red ink on claim forms
Circle on claim forms
Add extraneous information to any field
•
•
•
•
•
Use highlighter on any field
Submit photocopies or black and white
forms
Submit carbon copied claim forms
Submit claim forms via fax
Send a copy of the claim or a claim form
with a reconsideration or dispute
Corrected Claims, Claim
Reconsiderations, Claim Disputes Adjusted or Corrected Claim
Attn: Corrected Claim
P.O. Box 3060Farmington, MO 63640-3822
Request for Reconsideration (First Level Dispute)** Attn: Reconsideration
P.O. Box 3060Farmington, MO 63640-3822
Claim Dispute (Second Level Dispute)** Attn: Claim Dispute
P.O. Box 3060Farmington, MO 63640-3822
*Do not send a copy of the claim or a claim image (any version of the claim) with your claim reconsideration or claim dispute
**Utilize the Claim Reconsideration Request form and Claim Dispute form located on mmp.MeridianTotal.comunder the “Forms” section here: https://mmp.MeridianTotal.com/mmp/for-providers0/provider-resources/ manuals-forms-resources.html
CMS 1500 – Professional
Paper Claim Form
Important Notes:
1: Box 24J: Top Gray Area= Taxonomy
Bottom White Area= NPI
2: Box 33: Billing Provider Information
1
2
CMS 1500 Billing
Form InstructionsItem Field Requirement Description/Instructions
1 Required Indicate the type of health insurance for which the claim is being submitted for. For example, check Medicaid
1a Required Enter the member's Medicaid ID #
2 Required Enter in the member's full name; last name, first name, middle initial
3 Required Enter in the member's date of birth using MMDDYYY and sex checking the box for member's gender
5 Optional Enter in the member's address
6 Required Checkmark "self"
21 Required Enter in the diagnosis code(s) for the member
22 Optional Enter in resubmission code with original claim reference number
23 Required Enter in the authorization number (if applies)
24 A-G Required This section is comprised of six service lines that are divided horizontally. A valid claim must have at least one completed service line
24A Required
Enter in the dates of service using a MMDDYYYY. A "from" date and "to" date must be entered and have occurred after t he date the claim is
submitted
24B Required A two-digit place of service is required
24D Required Enter the appropriate procedure/service code
24E Required Enter a "1" in this field. This points to the diagnosis code you place in field 21
24F Required Enter in the total charge for the service line
24G Required Enter in the amount of units of service billed as appropriate
24J Required Enter in the providers Taxonomy code in the gray area on top and the NPI number in the bottom white are
25 Required Enter in the providers Tax ID number - also check the box to determin which topy of Tax ID number is being used
26 Optional This is a reference number for the member.
27 Required
Checkmark "yes"
28 Required Enter in the total of all service line charges. The total charge amount must equal the sum of all service line charges.
31 Required
A signature and date are required. It can be an original signature, stamped, typewritten, or p rinted. It must be the name of a person - it cannot
be "signature on file" or t he name of a facility. Use MMDDYYYY
32 Required Enter the service location name and address
33 Required Enter in the billing provider's name, address, and phone number
CMS 1450 (UB-04) Institutional
Claim Form
Electronic Billing InquiriesACTION CONTACT
If you would like to transmit claims electronically… Contact one of the clearinghouses for MeridianTotal's payer ID.
If you have a general EDI question…
Contact EDI Support at 800-225-2573 Ext. 6075525 or via email at
If you have questions about specific claims transmissions
or acceptance Claim Status reports… Contact your clearinghouse technical support area.
If you have questions about your Claim Status (if claim
has been accepted or rejected by the clearinghouse)…
Contact EDI Support at 800-225-2573 Ext. 6075525 or via email at
If you have questions about claims that are reported on
the Remittance Advice… Contact Provider Services at 877-941-0482
If you would like to update provider, payee, UPIN, Tax ID
number or payment address information…
Please submit changes via e-mail to [email protected]
For questions about changing or verifying provider
information… Contact Provider Services at 877-941-0482 or by fax 844-409-5557
•
•
HFS Sterilization Forms
–HFS 2189
Must be completed and
signed by both patient
and physician
See arrow pointing out
section with important
instruction information –
this section needs to be
indicated per HFS or
claim will be denied.
Acknowledgment of Receipt of
Hysterectomy Information
Form-HFS 1977
This needs to be
completed and signed by
the patient and Physician
Common Causes of
Upfront Rejections •
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Unreadable Information – Information within the claim form cannot be read. The ink is faded, too light, or too bold
(bleeding into other characters or beyond the box), the font is too small, or information is hand written or submitted
on a black and white claim form.
Member Name or identification (ID) number/DOB (date of birth) is missing or invalid.
Provider Name, Taxpayer Identification Number (TIN), or National Practitioner Identification (NPI) number is
missing.
DOS – The DOS (date of service) on the claim is not prior to receipt of claim (future date of service).
DATES – A date or dates are missing from required fields. Example: “Statement From” UB-04 & Service From”
1500 (02/12). “To Date” before “From Date”.
TOB – Invalid TOB (Type of Bill) entered.
Diagnosis Code is missing, invalid, or incomplete.
Service Line Detail – No service line detail submitted.
DOS (date of service) entered is prior to the member’s effective date.
Admission Type is missing (Inpatient Facility Claims – UB-04, field 14)
Patient Status is missing (Inpatient Facility Claims – UB-04, field 17).
Occurrence Code/Date is missing or invalid.
RE Code (revenue code) is missing or invalid.
CPT/Procedure Code/Modifier is missing or invalid.
CLIA – Missing/incomplete/invalid CLIA certification number.
Wrong/Incorrect Form Type – The paper claim form submitted is not on a “red” dropout OCR form, not accepted
by IlliniCare Health or not allowed for the provider type
Common Causes of Claim
Processing Delays and
Denials •
•
•
•–
•–
•
•
•
•
•
•
Diagnosis Code is missing the 4th, 5th, and 6th character requirements and 7th
character extension requirements
DRG code is missing or invalid
EOB (Explanation of Benefits) from the Primary insurer is missing or incomplete
Claim submission timeframe has expired
Claim was not submitted within 180 days from date of service or date of discharge, whichever is
later
Claim is an exact duplicate of previously submitted claim
If the intent is to dispute the original claim outcome, submit a Request for Reconsideration when
no changes on the claim are needed
Place of Service Code is invalid
Provider TIN and NPI does not match
Dates of Service span do not match the listed Days/Units
Physician Signature is missing
Tax Identification Number (TIN) is invalid
Third Party Liability (TPL) information is missing or incomplete