1. How can I check the status of my Medical Assistance claims? Show Note: When performing a claim inquiry for claims submitted via a media other than the internet, please allow for processing time before the claim appears in the system. For example, if you submit your claims via paper, please allow 7 to 10 business days before performing a claim inquiry. Alternatively, you may also contact the Provider Service Center at 1-800-537-8862 to inquire on the status of claims. 2.
What is the time limit for submitting claims to Medical Assistance? Resubmission of a rejected original claim must be received by the department within 365 days of the date of service, except for nursing facility providers and ICF/MR providers. Resubmission of a rejected original claim by a nursing facility provider or an ICF/MR provider must be received by the department within 365 days of the last day of each billing period. 3. How do I request an exception to the 180-day or 365-day time limit for submission or resubmission of invoices?
To submit a 180-day exception request, you must complete the following steps.
Submit a request for a 180-Day exception to the following address:
4. If I bill paper invoices, must the physician sign the MA invoice? 5. If I bill paper invoices, must the
patient sign the MA invoice? A parent, legal guardian, relative, or friend may sign his or her own name on behalf of the recipient. The provider or an employee of the provider does not qualify as an agent of the recipient; however, children who reside in the custody of a County children and youth agency may have a representative or legal custodian sign the claim form or the MA 91 for the child. The following situations do not require that the provider obtain the recipient's signature:
In all of the above situations, print "Signature Exception" on the recipient's signature line on the invoice. Physicians must bill drug claims using the electronic 837 Professional Drug
transaction if using proprietary or third party vendor software, or on the PROMISe™ Provider Portal using the pharmacy claim form. Physicians are required to use the 11-digit National Drug Code (NDC) and assign a prescription number for the medication. For additional information, please refer to the DHS website for information on Pharmacy Services or PROMISe Provider
Handbooks and Billing Guides 7. I have not seen my claim(s) on a piece of remittance advice – what should I do? If you submit paper claim forms, please verify that the mailing address is correct. Refer to Provider
Quick Tip #41 MEDICAL ASSISTANCE (MA) DESK REFERENCE to verify the appropriate PO Box to mail paper claim forms based upon claim type. 8. Are "J" codes compensable under Medical Assistance? 9. Can I print out the ADA 2012 Dental Claim Form from
the Department of Human Services website? 10. How do I submit claim adjustments on PROMISe™? 11. Will modifiers continue to be used after local codes
are eliminated? 12. When billing for services provided in a hospital setting, where can I find facility
numbers? 13. How do Outpatient Hospital providers bill MA secondary to Medicare? To bill MA secondary charges via the institutional claim form on the PROMISe™ Provider portal, follow these steps:
To bill MA secondary charges via the UB-04 paper claim form, follow these steps:
14. Is there a revenue code table for inpatient and outpatient? 15. Are emergency room services still billed with "W" codes? 16. Can we bill for services provided to a newborn using the mother's Recipient ID number?
If you bill via the PROMISe™ Provider portal, you must complete the Newborn section of the claim form and enter the mother's 10-digit ID number in the Patient ID field. Additionally, you must complete the billing notes with the mother's name, date of
birth and SSN. For more detailed information on billing without the Newborn's Recipient Number, institutional and professional providers may refer to the provider handbooks and billing guides located at: 17. For second digit bill classification, do we use a "4" when we bill for special
treatment room "X" codes? What if other services are on the same bill type? If other outpatient services are performed on the same date of service for which you are billing, you must separate the charges and bill the outpatient charges using bill type 131. 18. Does PROMISe™ accept the MD license number or the UPIN number for the physician format? 19. What are the options for submitting claims electronically? 20. Claims are rejecting due to "other insurance" even when that insurance is no longer valid for an individual. How can this be
corrected? 21. How should immunizations for EPSDT screens be reported on the CMS-1500 claim form? 22. Are diagnosis codes required when billing for all claim types?
23. Can claim adjustments be submitted electronically? 24. Can ASCs and SPUs submit more than one claim line per invoice?
25. The billing guides on the DHS website only refer to submitting the CMS-1500 paper claim form.
Where do you go for assistance when billing electronically. If you submit claims via the PROMISe™ Provider Portal, the user manual located here will assist you with your claim submissions. 26. How can I get training? I took the e-Learning course and still do not understand. Which of the following steps is needed to obtain pre certification?Which of the following steps is needed to obtain precertification? Call provider services phone number on the back of the patient's health insurance ID card. Provide the insurance company with procedures/services requested and the diagnoses. Document the outcome of the call in the patient's health record.
What is the first step in filing a claim with a third party?In order to file a third-party claim, you have to know the at-fault driver's name, auto insurance policy number, phone number, and details about the accident. Then, you can work with your own insurance company to file the third-party claim — or you can do it yourself through the other driver's insurance company.
Which procedure codes are most often used by physicians rendering services?What Are CPT Codes? CPT stands for Current Procedural Terminology system of codes, and was developed by the American Medical Association. These codes are used to identify the services rendered by a physician in a clinic.
Which of the following is typically documented in the Explanation of Benefits EOB )? Quizlet?The patient's deductible or co-insurance financial responsibility is typically documented on the EOB.
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