Avoiding/Correcting This Error
Verify the admission date, from, and through dates on the claim and compare the dates to the MAO/HMO entitlement dates.
Outpatient facilities and IPPS and IRF hospitals, or LTCH billing services within an [...]
Avoiding/Correcting This Error
Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS/DDE Provider Online System, HETS or NGSConnex to verify [...]
Avoiding/Correcting This Error
Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates.
Outpatient facilities and inpatient noninpatient PPS and IRF hospitals, or LTCH billing [...]
Avoiding/Correcting This Error
Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider Online System, HETS or NGSConnex to verify beneficiary [...]
Avoiding/Correcting This Error
If the beneficiary is entitled to Medicare Part B, an ancillary claim may be submitted to your MAC.
Related Content
Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]
Avoiding/Correcting This Error
If duplicate claim was submitted in error, no additional provider action is necessary. If it is determined that the claim was due to additional charges for a patient for a specific date of service, wait for the [...]
Avoiding/Correcting This Error
Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider [...]
Avoiding/Correcting This Error
Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]
Avoiding/Correcting This Error
Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]
Avoiding/Correcting This Error
Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]
Avoiding/Correcting This Error
If services are unrelated to hospice stay, resubmit with condition code 07 (treatment of nonterminal illness for hospice patient).
Verify hospice enrollment prior to claim submission by reviewing the CWF, HETS [...]
Avoiding/Correcting This Error
Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]
Avoiding/Correcting This Error
If the beneficiary is entitled to Medicare Part B, an ancillary claim may be submitted to your MAC.
Related Content
Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]
Avoiding/Correcting This Error
Verify billing and if appropriate, correct and resubmit the claim.
To prevent this error on future claims: Ensure that the correct bill type is submitted once you have received all charges from all [...]
Avoiding/Correcting This Error
If duplicate claim was submitted in error, no additional provider action is necessary. If it is determined that the claim was due to additional charges for a patient for a specific date of service, wait for the [...]
Avoiding/Correcting This Error
Always verify the status of a submitted claim before submitting another claim. Verify claim status using the IVR system, FISS/DDE or the NGSConnex online portal. Per CMS mandate, PCC representatives are not [...]
Avoiding/Correcting This Error
If appropriate, correct and resubmit a new claim.
To prevent this error on future claims: Ensure you have received all charges from all departments and that no claim has been submitted for the same DOS [...]