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July 4, 2024, 6:34 pm

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Enter the number of units identified as being paid from the other payer's EOB/EOMB. From the dropdown menu options, select the code identifying type of insurance. Assignment/ Plan Participation. Taxonomy code for occupational therapist. When using a consolidated NPI, a table will display showing the locations and taxonomy code(s) information on file with MHCP. Release of Information. Select the radio button next to the location where the service(s) was provided. If different than the provider reported on the claim information screen: Select one of the following screen action buttons: Note: You must always select Save/View Lines(s) after entering all lines to see the validate and submit action buttons.

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Select one of the following: Subscriber. Adjudication - Payment Date. Other Providers- Select the Other Providers accordion panel when required to report other provider information on the service line, if different than what was reported at the claim level.

Attachment Control Number. This code must match the HCPCS code entered on your service authorization (SA). Home Health Aide Visit Extended (waivers). Submitting an 837I Outpatient Claim. Claim Filing Indicator. The zip code for the address in address fields 1 and 2. Prior Authorization Number. Situational (Continued) Claim Information. Enter the Identifier of the insurance carrier.

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Enter the code identifying the general category of the payment adjustment for this line. Principal Diagnosis Code. Skilled Nurse Visit Telehomecare. From the dropdown menu options, select the relationship of the MHCP subscriber (recipient) to the policy holder. Enter the unit(s) or manner in which a measurement has been taken. Enter the appropriate revenue code used to specify the service line item detail for a health care institution. Enter the claim number reported on the Medicare EOMB. C laim Adjustment Group Code. Home Health Aide Visit. Enter the code identifying the reason the adjustment was made. When reporting TPL at the claim (header level), enter the non-covered charge amount. When appropriate, enter the service authorization (SA) number. Other Providers (Claim Level) – Select the Other Providers accordion screen when required to report other provider information. Pediatric occupational therapy taxonomy code. Coordination of Benefits (COB).

Copy, Replace or Void the Claim. Benefits Assignment. This must be the date the determination was made with the other payer. From the drop down menu, select whether the diagnosis code reported on this claim is in the ICD-9 or ICD-10 classification. Pro cedure Code Modifier(s). Other Payers Claim Control Number. Telephone number reported on the provider file. When reporting TPL adjustments at the claim (header level), enter the prior payer paid amount. Adjustment Reason Code. Enter the policy holder's identification number as assigned by the payer. Use the Washington Publishing Company (WPC) health care codes lists to identify the claim status category and claim status codes displayed on the validate and submit claim response. Home Care Servies Billing Codes. Taxonomy for occupational medicine. Enter the total adjusted dollar amount for this line. Enter the total dollar amount of the specific adjustment for the reason code entered on this service line.

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For header (claim) level adjustment, select the code identifying the general category of the payment adjustment for this line from the dropdown menu options. Enter the name of the Medicare or Medicare Advantage Plan. This is the code indicating whether the provider accepts payment from MHCP. Other Payer Primary Identifier. Select the appropriate source code from the dropdown menu options, indicating the point of location/origin for this admission or visit. Enter the HCPCS code identifying the product or service. Physical Therapy Assistant Extended. Enter a unique identifier assigned by you, to help identify the claim for this recipient. Enter the name of the TPL insurance payer. From the dropdown menu options, select the code identifying the insurance carrier's level of responsibility for payment. The first 9 skilled nurse visits in a calendar year do not require an authorization unless the recipient has a current waiver service authorization SA)].

Non-Covered Charge Amount. Select the appropriate response from the dropdown menu options, to identify the priority of the admission/visit. For Medicare this would be the Medicare health insurance claim number (HICN) or the Medicare beneficiary identifier (MBI) number. Enter the date of payment or denial determination by the Medicare payer for this service line. Enter the total charge for the service. Use only when submitting a claim with an attachment. This is the determination of whether the provider has a signed statement by the recipient on file, authorizing the release of medical data to other organizations.

Enter the service end date or last date of services that will be entered on this claim. An authorization number is not required if there is no authorization in the system and the service is a skilled nurse visit. Enter the highest level of ICD or other industry accepted code(s) that best describe the condition/reason the recipient needed the service(s). To (End) date not required as must be the same as the From (start) date of this line. The last name of the subscriber. Dates must be within the statement dates enterd in the Claim Information Screen. This is the determination of the policy holder or person authorized to act on their behalf, to give MHCP permission to pay the provider directly. Enter the date the item or service was provided, dispensed or delivered to the recipient. Situational Claim Information - Select the situational claim information accordion screen to report situational information when required. From the dropdown menu options, select the appropriate code indicating the disposition or discharge status of the recipient on the date entered in the statement Date (To) field.

Select Submit to identify if the claim will be paid, denied, or suspended for review at the claim and service line level of the claim. Enter the NPI listed on the Explanation of Medicare Benefits (EOMB) used to submit the claim to Medicare.