The CMS-1500 application form is used to submit non-institutional requests for health services from physicians, other providers, and providers to Medicare. It is also used to file claims with many private payers and Medicaid programs, as well as other government health insurance programs. Most requests for institute-related services are submitted using a Form UB-04. Vendor contracts and billing policies provide additional instructions for closing claims. If you`d like to study the outsourcing of claims and settlements, consider the factors to consider when choosing a professional billing service. Some Medicare beneficiaries have secondary insurance policies (e.B. commercial insurance through a partner`s work or policy), which provides benefits and coverage for terms beyond the standard Medicare Part B MNT benefit (e.B DM, CKD and 3 years after kidney transplant). The second payer may require proof of a denied claim from Primary Insurance (Medicare) before paying the claim (e.B. NCD for a gastroenterological or other diagnosis). A claim is submitted to Medicare, which must include a modifier (GA, GZ, or GY) to generate a rejection that is required before secondary insurance reviews the claim. For more information, including descriptions and usage of each modifier, see RDN`s Complete Guide to Accreditation and Billing: The Private Payer Market or page 8 of the CMS manual. Specific customer and provider information must be provided on a CMS 1500 health insurance application form so that a payer can process a claim regardless of how it is submitted. Some payers may require additional information or, in certain situations, require certain fields to be completed (e.g.B.
group number, pre-approval reference number, workers` compensation). The information provided here to assist RDRs in completing an application form is general. For more information, see each payer`s billing instructions or contact a health plan representative for claims options. Refer to the following example of a completed claim and a quick reference to help you complete a CMS 1500. Medicare transactions for electronic claims must meet the requirements of electronic data exchange. Medicare RDN providers can file claims with applications that meet Medicare EDI requirements. Suppliers must enter into an EDI registration agreement. Registered dietitians can file applications electronically with a Medicare Administrative Contractor (MAC). Dietitians should contact their MACs for more information. When you file claims electronically (para.
B using a clearing house), you also select a payer ID and a unique code for each payer. Some payers may require providers to enter into an agreement before accepting electronic claims through a third-party service such as a claims clearing house. Alternatively, Claims Clearinghouses allows you to select participating payers from a menu. For more complete instructions on filing claims, see RDN`s Complete Guide to Accreditation and Billing: The Private Payer Market. The form specifications require red ink to facilitate the use of image processing technologies such as image character recognition (ICR), fax transmission, and image storage. It is available in different formats (e.B. single copy, duplicate, etc.). The CMS-1500 application form can be purchased from local printers, office supply stores, or in the United States. Government Impression: Payment of MNT claims provided in the outpatient setting depends on several factors, including a person`s benefits to MNT based on their condition or reason (p.
ex. B, prevention), approved parameters and rdn network status (or practice) with the client/patient payer. Claims can be submitted electronically to payers via many vehicles, including practice management systems, vendor portals, and claims settlement offices. There may be cases where paper claims are still being used. U.S. Government Printing Office Superintendent of Documents Washington, DC 20402 Pricing Desk: 202/512-1800 or 866/512-1800 Fax: 202/512-2104 Email: ContactCenter@gpo.gov bookstore.gpo.gov. . . .