2017 4th Quarter Newsletter
|
|
|
- Leonard Hampton
- 5 years ago
- Views:
Transcription
1 MCR Part B Monthly Premium-$134 MCR Part B Annual Deductible-$183 MCR Part A Inpatient Hospital Deductible-$1,340 per benefit period The Centers for Medicare & Medicaid Services (CMS) announced the 2018 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs. Medicare Part B Premiums/Deductibles Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and other items. The standard monthly premium for Medicare Part B enrollees will be $134 for 2018, the same amount as in Some beneficiaries who were held harmless against Part B premium increases in prior years will have a Part B premium increase in 2018, but the premium increase will be offset by the increase in their Social Security benefits next year. CMS also announced that the annual deductible for all Medicare Part B beneficiaries will be $183 in 2018, the same annual deductible in Premiums and deductibles for Medicare Advantage and Medicare Prescription Drug plans are already finalized and are unaffected by this announcement. Medicare Part A Premiums/Deductibles The Medicare Part A annual inpatient hospital deductible that beneficiaries pay when admitted to the hospital will be $1,340 per benefit period in 2018, an increase of $24 from $1,316 in For a fact sheet on the 2018 Medicare Parts A & B premiums and deductibles, please visit:
2 Starting on January 1, 2018, TRICARE will have some changes. The three regions will become two. TRICARE North and TRICARE South will combine to form TRICARE East. TRICARE West will remain unchanged. Region New Regional Contractor (Effective Jan 01, 2018) East West Humana Military Health Net Federal Services TRICARE Select replaces TRICARE Standard and Extra. TRICARE Select is a selfmanaged, preferred provider network plan. Those enrolled in TRICARE Prime and TRI- CARE Young Adult, TRICARE Reserve Select, TRICARE Retired Reserve or the Continued Health Benefit Program will remain enrolled in their current plan. Introducing TRICARE Select: If on Dec 31, 2017 Then on Jan 01, 2018 You re enrolled in TRICARE Prime You ll remain enrolled in TRICARE Prime. You re covered under TRICARE Standard You re enrolled in: TRICARE Young Adult, TRICARE Reserve Select, TRICARE Retired Reserve Continued Health Benefit Program You ll be automatically converted to TRICARE Select. You ll remain enrolled in your current plan.
3 Applies To: Providers submitting procedure codes subject to multiple procedure payment rules. Background: Two services with the same fee schedule amount, with an MPFSDB amount lower than the billed amount, are processed on the same day (same or different claims). The Medicare Multi-Carrier System (MCS) determines which service is allowed at 100% and which service(s) are subject to multiple procedure reductions. On a weekly basis, MCS automatically creates adjustments; this process identifies claims MCS thinks are initially allowed incorrectly. In some situations, MCS is creating unnecessary adjustments., multiple times for the same claim. In addition, some of the adjustments cause all lines to be reduced, leaving none at 100% allowed. Noridian Action: Noridian has contacted and reported this to MCS for resolution. 02/13/17-06/06/17-The MCS system maintainer is currently researching. No estimated date of resolution is currently available. 06/07/17-A solution is scheduled to be implemented by the MCS maintainer on 10/02/17. Noridian will provide additional guidance regarding the solution and any direction on adjustments in early October. 10/02/17-The MCS maintainer implemented a system correction on 10/02/17. Provider Action: 10//02/17-Noridian is unable to automatically identify claims/adjustments impacted by this issue. Providers with incorrect reductions should contact the Provider Contact Center to have their impacted claims readjusted for proper processing. Date Reported: 01/25/17 Date Resolved: 10/02/17 The election period is open to form a virtual group for the 2018 Merit-Based Incentive Payment System (MIPS) performance period. As proposed in the 2018 Quality Payment Program proposed rule, solo practitioners and groups can choose to participate in MIPS as a virtual group for the 2018 performance period through an election process through December 1, CMS proposed a virtual group to be a combination of two or more Taxpayer Identification Numbers (TINs) made up of: A solo practitioner who is eligible to participate in MIPS and bills under a TIN with no other National Provider Identifiers billing under the TIN, or A group with 10 or fewer eligible clinicians (at least 1 must be eligible for MIPS) that joins with at least one other solo practitioner or group for a performance period of a year
4 Enrollment Application Status Search Tool Available Soon Have you submitted an enrollment application to Noridian and wish you could check its status without picking up the phone? The Enrollment Application Status Search Tool is coming! This web-based self-service tool will allow providers and suppliers to follow the application progress by entering an Application/Reference Number or Web Tracking ID. If a match is identified, the results will vary depending on the application progression. The below indicates the high-level progression levels. Additional verbiage may be included, if/when necessary. Received In Progress Corrections Requested Completed Unable to Complete For additional inquiries beyond an application status, contact the Provider Enrollment Contact Center. National Government Services has noticed providers are submitting reopenings through the NGSConnex portal and then submitting a new claim; this activity of duplicate claim submission is inappropriate. CMS created the clerical error reopening to correct the initial claim determination. Therefore, if you find that your claim is a clerical error reopening, please make sure you correct the initial claim determination through the NGSConnex portal. If you are not using the NGSConnex for clerical error reopenings, please register.
5 2017 Highlights & Achievements The glitch that was causing podiatry services to be denied when applied to the MCR deductible has been corrected after meeting with DOH. Harold Iselin arranged and participated along with the insurance committee in this productive meeting. The Insurance committee is working with the APMA in attempting to access the Milliman criteria utilized by Fidelis as the basis for coverage (Denials of L3000 services). After the Insurance Committee meeting with Healthcare Partners the burden of pre-authorizations has been resolved. The effective date of these changes have yet to be determined. All podiatrists should continue as is until this date is communicated. Molina Health Care has been denying all podiatry services for nondiabetics and patients over 21 years of age. The Insurance committee is working on reversing this policy. Emblem/HIP cleared up the internal systems issue they were having regarding HIP capitation payments. With APMA efforts, CPT Code A5513 can be billed in cases where computerized technology is being utilized to create the cast for devices.
6 Stay tuned.2018
2016 Medicare Deductibles and Premiums
2016 Medicare Deductibles and Premiums Yesterday the Centers for Medicare & Medicaid Services (CMS) announced the 2016 premiums and deductibles for the Medicare inpatient hospital (Part A) and physician
Should Federal Retirees Enroll in Medicare?
Should Federal Retirees Enroll in Medicare? January 17, 2019 - By Edward A. Zurndorfer, Certified Financial Planner Federal employees have numerous questions as they plan for their retirement from federal
An Introduction to Medicare
An Introduction to Medicare Medicare can be confusing, but we re here to help you and your employees make sense of it all. This Medicare overview is a great place to start. It goes over the Medicare basics
CONTRACT YEAR 2018 MEDICARE ADVANTAGE PRIVATE FEE-FOR-SERVICE PLAN MODEL TERMS AND CONDITIONS OF PAYMENT
CONTRACT YEAR 2018 MEDICARE ADVANTAGE PRIVATE FEE-FOR-SERVICE PLAN MODEL TERMS AND CONDITIONS OF PAYMENT Table of Contents 1. Introduction 2. When a Provider is Deemed to Accept Today s Options PFFS Terms
4 Learning Objectives (cont d.)
1 2 Learning Objectives Define pertinent TRICARE and CHAMPVA terminology and abbreviations. State who is eligible for TRICARE. Explain the differences of the TRICARE Standard government program. List the
CY 2018 Quality Payment Program Final Rule Summary
CY 2018 Quality Payment Program Final Rule Summary On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) released its final rule outlining the requirements for year two of the Quality
Quality Payment Program Year 2
Quality Payment Program Year 2 MIPS Highlights Raising the performance threshold to 15 points in Year 2 (from 3 points in the transition year). Allowing the use of 2014 Edition and/or 2015 Certified Electronic
North Texas Specialty Physicians
A Guide to Medicare North Texas Specialty Physicians Known as NTSP is an Independent Physician Association comprised of more than 1,000 family and specialty doctors dedicated to delivering the best care
Health Coverage Options Guide
Health Coverage Options Guide Overview At Fresenius Kidney Care, we know that providing superior patient care goes beyond delivering industry leading dialysis services. We also strive to help patients
Click this button to place your order.
2018 Medicare 35th Edition What you need to know about Medicare in simple, practical terms. Click this button to place your order. 2018 MEDICARE CONTENTS 1 2 3 4 5 6 Published By PAGE INTRODUCTION Are
Billing and Payment. To register, call UHC-FAST ( ) or your local Evercare provider representative.
Billing and Payment Billing and Claims On the Web www.unitedhealthcareonline.com Register for UnitedHealthcare Online SM, our free Web site for network physicians and health care professionals. At UnitedHealthcare
My Medicare Options Workbook
My Medicare Options Workbook This workbook will walk you through the process of deciding what steps you need to take now that you are eligible for Medicare. Table of Contents Introduction... 3 Where do
SDMGMA Third Party Payer Day. Chelsea King, Policy Analyst
SDMGMA Third Party Payer Day Chelsea King, Policy Analyst Agenda Medicaid Overview Third Party Liability Common TPL Errors NDC Claims Processing Anesthesia Claims Online Portal Q & A Medicaid Overview
Understanding Your Medicare Options. Medicare Made Clear
Understanding Your Medicare Options Medicare Made Clear 1. Eligibility 2. Coverage Options 3. Enrollment 4. Next Steps 5. Resources Agenda 2 ELIGIBILITY Medicare Made Clear ELIGIBILITY Original Medicare
Provider Healthcare Portal Demonstration:
Provider Healthcare Portal Demonstration: Claim Denials Professional Claims (CMS-1500) HPE October 2016 Agenda Getting started Searching claims Copying and correcting claims Most common denials; how to
Medicare Advantage FAQ
Medicare Advantage FAQ Contents Medicare Advantage Talking Points... 2 University of Richmond Medicare Advantage Plan Questions... 3 Provider Acceptance Questions... 4 Claims Processing... 6 Frequently
Pamela Ballou-Nelson, RN, MSPH, CMPE, PhD, Principal, MGMA Consulting April 10, , Telligen, Inc.
MIPS 2018 Cost Reporting and Your QRUR Pamela Ballou-Nelson, RN, MSPH, CMPE, PhD, Principal, MGMA Consulting April 10, 2018 2016, Telligen, Inc. Quality Payment Program Cost Reporting Quality Payment Program
Fidelis Care uses TriZetto's Claims Editing Software to automatically review and edit health care claims submitted by physicians and facilities.
BILLING AND CLAIMS Instructions for Submitting Claims The physician s office should prepare and electronically submit a CMS 1500 claim form. Hospitals should prepare and electronically submit a UB04 claim
Chapter 1 Section 38. Reimbursement of State Vaccine Programs (SVPs)
General Chapter 1 Section 38 Issue Date: November 29, 2017 Authority: 32 CFR 199.6(d)(5); 32 CFR 199.14(j)(4); National Defense Authorization Act for Fiscal Year 2017 (NDAA FY 2017, Public Law (PL) 114-328
Understanding Your Medicare Options. Medicare Made Clear
Understanding Your Medicare Options Medicare Made Clear Top Medicare questions 1 Who is eligible for Medicare? 2 What are my coverage options? 3 When can I enroll? 4 What are my next steps? 5 Once I am
Advocate Medicare Resource
Advocate Medicare Resource Understanding Medicare Options About this Guidebook This guidebook has been designed to assist Medicare beneficiary patients in understanding the basics of Medicare and Medicare
SDMGMA Third Party Payer Day. Anja Aplan, Payment Control Officer
SDMGMA Third Party Payer Day Anja Aplan, Payment Control Officer Agenda Medicaid Overview Third Party Liability Common TPL Errors NPI and Taxonomy Billing Transportation Billing Diagnosis codes Aid Category
Summary of the Quality Payment Program (QPP) Year 2 Final Rule
November 8, 2017 Summary of the Quality Payment Program (QPP) Year 2 Final Rule Medicare Program; CY 2018 Updates to the Quality Payment Program; and Quality Payment Program: Extreme and Uncontrollable
Medicare Advantage Private Fee-for-service Plan Model Terms and Conditions of Payment
Medicare Advantage Private Fee-for-service Plan Model Terms and Conditions of Payment Table of Contents 1. Introduction 2. When a provider is deemed to accept Humana Gold Choice PFFS terms and conditions
. The A, B, C and D s ( )
The World of Medicare. The A, B, C and D s 1 021749 (03-2010) Today Original Medicare Part A Part B Medicare Advantage Plans Part C Prescription Drug Plans Part D Medicare Supplement Insurance Serving
2018 Merit-based Incentive Payment System (MIPS) Cost Performance Category Fact Sheet
2018 Merit-based Incentive Payment System (MIPS) Cost Performance Category Fact Sheet What is the Quality Payment Program? The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable
SHIBA Senior Health Insurance Benefits Assistance
Your Medicare Health Plan Choices SHIBA Senior Health Insurance Benefits Assistance In compliance with the Americans with Disabilities Act (ADA), this publication is available in alternative formats. Call
HEALTH MATTERS A PUBLICATION FOR TRICARE BENEFICIARIES
HEALTH MATTERS A PUBLICATION FOR TRICARE BENEFICIARIES Make 2019 TRICARE Enrollment Changes This Fall TRICARE Open Season Begins Nov. 12 Do you want to make enrollment changes to your or your family member
Rate Component Overview
Oxford Health Plans (NY), Inc. Oxford Health Insurance, Inc. New York Small Group POS Plans Narrative Summary of Requested Rate Changes Effective 4th quarter 2013 We have prepared this Narrative Summary
Health Information Technology and Management
Health Information Technology and Management CHAPTER 9 Healthcare Coding and Reimbursement Pretest (True/False) CPT-4 codes are used to bill for disease and illness. Medicare Part B provides medical insurance
Getting started with Medicare
Getting started with Medicare Look inside to: Learn about Medicare Find out about coverage and costs Discover when to enroll Medicare Made Clear Learning about Medicare can be like learning a new language.
QUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW NOVEMBER 15, 2018
QUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW NOVEMBER 15, 2018 Disclaimers This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations.
Basics of Health Insurance. Copyright 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Basics of Health Insurance 1 The Purpose of Health Insurance The purpose of health insurance is to help individuals and families offset the costs of medical care. Helps protect against financial losses
Research and Resolve UB-04 Claim Denials. HP Provider Relations/October 2014
Research and Resolve UB-04 Claim Denials HP Provider Relations/October 2014 Agenda Claim inquiry on Web interchange By member number and date of service Understand claim status information, disposition,
2018 Quality Payment Program Final Rule. Summary
Summary On Thursday, November 3, 2017, CMS issued the 2018 Quality Payment Program (QPP) final rule. Comments on the final rule are due January 1, 2018. The QPP encompasses the Merit-based Incentive Payment
C H A P T E R 1 4 : Medicare and Other Insurance Liability
C H A P T E R 1 4 : Medicare and Other Insurance Liability Reviewed/Revised: 10/1/2018 14.0 FIRST AND THIRD PARTY/OTHER COVERAGE Steward Health Choice Arizona, as an AHCCCS contractor is the payor of last
Billing Guidelines Manual for Contracted Professional HMO Claims Submission
Billing Guidelines Manual for Contracted Professional HMO Claims Submission The Centers for Medicare and Medicaid Services (CMS) 1500 claim form is the acceptable standard for paper billing of professional
WEBINAR: Nov. 20, 2017, 1 p.m. EST Take Command The Future of TRICARE
WEBINAR: Nov. 20, 2017, 1 p.m. EST Presenters: Mark Ellis, Senior Health Program Analyst for TRICARE, Defense Health Agency; Shane Pham, Health Program Analyst for TRICARE, Defense Health Agency Disclaimer
For your convenience, submit this form and any payment due electronically via the eservices portal located at or fax
For your convenience, submit this form and any payment due electronically via the eservices portal located at www.palmettogba.com/eservices or fax this form and required documentation to (803) 870-0147.
Coverage Determinations, Appeals and Grievances
Coverage Determinations, Appeals and Grievances Filing a grievance (making a complaint) about your prescription coverage Asking for a coverage determination (coverage decision) 60-day formulary change
2018 Quality Measure Benchmarks Overview
2018 Quality Benchmarks Overview What Are Quality Benchmarks? When a clinician or group submits measures for the Merit-based Incentive Payment System (MIPS) quality performance category, each measure is
April 10, THN Approval Council: Compliance and Integrity Committee
Policy Title: 3-Day SNF Rule Waiver Benefit Enhancement Department Responsible: Compliance and Integrity Policy Number: 1.95 THN s Effective Date: April 10, 2017 Next Review/Revision Date: April 2018 Title
Copyright Scottsdale Institute All Rights Reserved.
Copyright Scottsdale Institute 2017. All Rights Reserved. No part of this document may be reproduced or shared with anyone outside of your organization without prior written consent from the author(s).
Reopening and Redetermination Submissions
A CMS Medicare Administrative Contractor http://www.ngsmedicare.com Reopening and Redetermination Submissions Understanding your next steps are very important for quick reimbursement and providers are
Getting started with Medicare
Getting started with Medicare Welcome You have important decisions to make when you become eligible for Medicare. Our goal is to help you understand your options and feel confident about choosing coverage
Overview of Plans for Medicare Eligible Members
Overview of Plans for Medicare Eligible Members The following pages offer general descriptions of the types of plans offered to CTPF retirees who are eligible for and maintain active enrollment in Medicare
Medicare Explained. AAII, November 10, Marcelo Espiritu, Director Health Insurance Counseling & Advocacy Program
Medicare Explained AAII, November 10, 2018 Marcelo Espiritu, Director Health Insurance Counseling & Advocacy Program 0 Helping Seniors Age Well at Home Sourcewise provides expertise, education, and quality
Prior Authorization All non-emergent services rendered by non-contracted providers require prior authorization, unless specified otherwise.
Prior Authorization All non-emergent services rendered by non-contracted providers require prior authorization, unless specified otherwise. Abortions, Hysterectomies and Sterilizations Ambulance Emergency
Final Policy, Payment, and Quality Provisions in the Medicare Physician Fee Schedule for Calendar Year 2018
Final Policy, Payment, and Quality Provisions in the Medicare Physician Fee Schedule for Calendar Year 2018 Date 2017-11-02 Title Contact Final Policy, Payment, and Quality Provisions in the Medicare Physician
Welcome. Medicare 101 Educational Seminar
Welcome Medicare 101 Educational Seminar 2 Basics of Medicare What Is Medicare? Medicare is a federally funded health insurance program. It includes Part A and Part B (known as Original Medicare). Medicare
Required Fields Are Indicated With An Asterisk* AGENT NUMBER (SAN)* MEDICAID NUMBER. Stamp Date. 1 Humana Medicare Enrollment Form
1 Humana Medicare Enrollment Form If you re currently enrolled in an OSB, you MUST choose PLAN OPTION*: it on this form to continue receiving this benefit. Not all OSB offerings are available in all areas.
How will this Fact Sheet help me?
FACT SHEET: Deciding Whether to Enroll in Medicare Part A and Part B When You Turn 65 How will this Fact Sheet help me? As you near age 65, you have to make several important decisions about your Medicare
Claim Reconsideration Requests Reference Guide
Claim Reconsideration Requests Reference Guide This reference tool provides instruction regarding the submission of a Claim Reconsideration Request form and details the supporting information required
Getting started with Medicare.
Getting started with Medicare. Look inside to: Learn about Medicare Compare plans and choose the right one for you See if you qualify for financial help Learn how to enroll in Medicare if you plan on working
Simple Facts About Medicare
Simple Facts About Medicare What is Medicare? Medicare is a federal system of health insurance for people over 65 years of age and for certain younger people with disabilities. There are two types of Medicare:
Medicare Part D Transition Policy
Medicare Part D Transition Policy Transition Policy for New and Current Enrollees of our Medicare Part D Prescription Drug Plan PURPOSE: Simply Healthcare Plans, Inc. must maintain an appropriate transition
Coverage and Billing Issues for Clinical Research
Coverage and Billing Issues for Clinical Research John E. Steiner, Jr., Esq Chief Compliance Officer Cleveland Clinic Health System Cleveland, Ohio The Second Annual Medical Research Summit Washington,
Having a plan designed to work for you.
YOUR ADVANTAGE: Having a plan designed to work for you. Northwestern University Post- 65 Retiree 2018 Benefit Plans Y0066_170927_092703 Proprietary information of UnitedHealth Group. Do not distribute
Legal Basics: Medicare Parts A, B, & C. Georgia Burke, Directing Attorney Amber Christ, Senior Staff Attorney
Legal Basics: Medicare Parts A, B, & C Georgia Burke, Directing Attorney Amber Christ, Senior Staff Attorney Tuesday, January 10, 2017 Justice in Aging is a national organization that uses the power of
MEDICARE CROSSOVER CLAIM SUBMISSION. October 2017 Webinar CHANGES EFFECTIVE 06/01/2016
MEDICARE CROSSOVER CLAIM SUBMISSION October 2017 Webinar CHANGES EFFECTIVE 06/01/2016 Disclaimer SoonerCare policy is subject to change. The information included in this presentation is current as of October
AC: MEDICARE CHOICES HOW TO NAVIGATE
AC: 26997-0516-8318 MEDICARE CHOICES HOW TO NAVIGATE MEDICARE HEALTH INSURANCE AT A GLANCE AGE 65 ELIGIBILITY Part A Part B Part D Medigap Part C WHAT IT COVERS Hospital Insurance (Inpatient services)
Welcome to the West TRICARE Changes in 2018
Welcome to the West TRICARE Changes in 2018 TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved. 1 Welcome to the West Since 1988, Health Net Federal
Medicare 101 and Senior Advantage Group Offering. Conejo Valley Unified School District November 16, 2009
Medicare 101 and Senior Advantage Group Offering Conejo Valley Unified School District November 16, 2009 What is Medicare? Medicare is a federally funded health insurance program Established in 1965 Administered
AMERICAN COLLEGE OF GASTROENTEROLOGY MAKING $ENSE OF MACRA
AMERICAN COLLEGE OF GASTROENTEROLOGY 6400 Goldsboro Road, Suite 200, Bethesda, Maryland 20817-5842; P: 301-263-9000; F: 301-263-9025 MAKING $ENSE OF MACRA CMS.SGR MACRA MIPS APMs QCDRs ACOs Why does Washington
Guide to Medicare Coverage Who qualifies for Medicare benefits? Individuals 65 years of age or older Individuals under 65 with permanent kidney
Guide to Medicare Coverage Who qualifies for Medicare benefits? Individuals 65 years of age or older Individuals under 65 with permanent kidney failure (beginning three months after dialysis begins), or
Medicare Releases Final Rule for the Second Year of the Quality Payment Program
Medicare Releases Final Rule for the Second Year of the Quality Payment Program On Nov. 2, 2017, CMS issued the Calendar Year 2018 Quality Payment Program (QPP) final rule for the second transition year
The MACRA Proposed Rule on MIPS and APMs: Summary and Key Takeaways
The MACRA Proposed Rule on MIPS and APMs: Summary and Key Takeaways A White Paper May 2016 Impact Advisors LLC 400 E. Diehl Road Suite 190 Naperville IL 60563 1-800- 680-7570 Impact- Advisors.com Executive
Legacy MedigapSM Outline of Medigap insurance coverage and enrollment application for Plan A and Plan C
Medicare Supplement Coverage offered by Blue Cross Blue Shield of Michigan Legacy Medigap SM Outline of Medigap insurance coverage and enrollment application for Plan A and Plan C Legacy Medigap plan
Proposed 2018 Medicare Physician Payment and Quality Reporting Changes. Executive s Insights
Proposed 2018 Medicare Physician Payment and Quality Reporting Changes MGMA MEMBER-EXCLUSIVE ANALYSIS The Centers for Medicare & Medicaid Services (CMS) recently proposed changes to both Medicare physician
Send all required documents (including this checklist) to:
Fallon Community Health Plan Fallon Senior Plan Premier HMO Check if Complete To ensure that your applications are processed as quickly as possible, just follow this checklist Employer completes and signs
Claims and Appeals Process for the Self-Funded Medical Plans Administered by UnitedHealthcare
SUPPLEMENT TO SUMMARY OF BENEFITS HANDBOOK FOR RETIREES AND SURVIVING DEPENDENTS Claims and Appeals Process for the Self-Funded Medical Plans Administered by UnitedHealthcare Filing a Claim for Benefits
Medicare Made Clear Answer Guide
Medicare Made Clear Answer Guide Y0066_100820_113217 File & Use 08252010 Medicare can be confusing. How do you find the best options to fit your needs? This guide has some answers that may be helpful.
Medicare consists of: Hospital insurance (Part A) Medical insurance (Part B) Medicare Advantage (Part C) Prescription drug plan (Part D)
Medicare Understanding the program s complexities The federal government administers the Medicare insurance program to help seniors afford health care. To fully benefit from the program, you need a grasp
Claim Form Billing Instructions CMS 1500 Claim Form
Claim Form Billing Instructions CMS 1500 Claim Form Item Required Field? Description and Instructions. 1 Optional Indicate the type of health insurance for which the claim is being submitted. 1a Required
Healthcare Options for Veterans
Healthcare Options for Veterans January 2017 (This information was copied from Unit 3 of Module 4 in the 2017 WIPA Training Manual) Introduction The U.S. Department of Defense (DoD) and the Department
CHAPTER 13 SECTION 16.1 WAIVER OF LIABILITY. NOTE: The word service(s), as used in this Section, will be understood to include services and supplies.
TRICARE/CHAMPUS POLICY MANUAL 6010.47-M DEC 1998 PAYMENTS POLICY CHAPTER 13 SECTION 16.1 Issue Date: April 8, 1989 Authority: 32 CFR 199.4 I. ISSUE Payment and liability for services or supplies retrospectively
Nursing Facility, Long-term Care Providers, and Intermediate Care Facilities for the Mentally Retarded
INDIANA HEALTH COVERAGE PROGRAMS P R O V I D E R B U L L E T I N B T 2 0 0 9 0 3 F E B R U A R Y 1 0, 2 0 0 9 To: Nursing Facility, Long-term Care Providers, and Intermediate Care Facilities for the Mentally
TRICARE Reimbursement Manual M, February 1, 2008 Double Coverage. Chapter 4 Section 4
Double Coverage Chapter 4 Section 4 Issue Date: Authority: 32 CFR 199.8 1.0 TRICARE AND MEDICARE 1.1 Medicare Always Primary To TRICARE With the exception of services provided by a Federal Government facility,
Choosing Between Traditional Medicare and Medicare Advantage
Choosing Between Traditional Medicare and Medicare Advantage If you are eligible for Medicare you can chose between getting Medicare benefits through traditional Medicare (also known as original Medicare
Melissa Scarborough, MPH, CHES Centers for Medicare & Medicaid Services Dallas Regional Office
Welcome to Medicare! Melissa Scarborough, MPH, CHES Centers for Medicare & Medicaid Services Dallas Regional Office The Affordable Care Act Patient Protection and Affordable Care Act (PPACA) Signed into
A FIELD GUIDE TO MEDICARE
Make the most of Medicare. To learn more about Transamerica s Field Guide to Medicare series and to get support materials: Contact: Your Financial Professional Transamerica Resources, Inc. is an Aegon
Facility Billing Policy
Policy Number 2018F7007A Annual Approval Date Facility Billing Policy 3/8/2018 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission
EVIDENCE OF COVERAGE:
EVIDENCE OF COVERAGE: Your Medicare Prescription Drug Coverage as a Member of Medi-Pak Rx Premier January 1 December 31, 2008. This booklet gives the details about your Medicare prescription drug coverage
2018 Medicare Part D Transition Policy
Regulation/ Requirements Purpose Scope Policy 2018 Medicare Part D Transition Policy 42 CFR 423.120(b)(3) 42 CFR 423.154(a)(1)(i) 42 CFR 423.578(b) Medicare Prescription Drug Benefit Manual, Chapter 6,
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services News Flash A new fast fact is now available on MLN Provider Compliance. This web page provides the latest educational products
Behavioral Health FAQs
Behavioral Health FAQs Authorizations & Notifications Q: The behavioral health prior authorization forms do not indicate what documentation to submit. What clinical information should I send with a prior
Evidence of Coverage. Simply Complete (HMO SNP) Offered by Simply Healthcare Plans , TTY 711
Evidence of Coverage Simply Complete (HMO SNP) Offered by Simply Healthcare Plans This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 December
PROVIDENCE MEDICARE DUAL PLUS (HMO SNP) MEMBER HANDBOOK EVIDENCE OF COVERAGE JAN. 1 DEC. 31, 2018
PROVIDENCE MEDICARE DUAL PLUS (HMO SNP) MEMBER HANDBOOK EVIDENCE OF COVERAGE JAN. 1 DEC. 31, 2018 January 1 December 31, 2018 Evidence of Coverage: Your Medicare Health Benefits and Services and Prescription
CHOC Health Alliance Downstream Provider Notice CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM
CHOC Health Alliance Downstream Provider Notice CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM As required by Assembly Bill 1455, the California Department of Managed Health Care has set forth
2018 Evidence of Coverage
Centers Plan for Dual Coverage Care (HMO SNP) 2018 Evidence of Coverage H6988_002_ANOC EOC1127 Accepted 09182017 January 1 December 31, 2018 Evidence of Coverage: Your Medicare Health Benefits and Services
QUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW
QUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW NEAL LOGUE, HEALTH INSURANCE SPECIALIST, DIVISION OF FINANCIAL MANAGEMENT & FEE FOR SERVICE OPERATIONS DECEMBER 12, 2018 Disclaimers This presentation
Medicare in Maryland Navigating Medicare and Understanding Your Options
Medicare in Maryland Navigating Medicare and Understanding Your Options H8854_17_4041-07_003_OE CMS Accepted 6/13/2017 Table of Contents Introduction... 1 Medicare: A Brief History... 2 The Four Parts
PRIMER: MACRA and the Merit-based Incentive Payment System (MIPS) Tara O Neill Hayes January 31, 2016
PRIMER: MACRA and the Merit-based Incentive Payment System (MIPS) Tara O Neill Hayes January 31, 2016 Background On April 16, 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into
DEFENSE HEALTH AGENCY 7700 ARLINGTON BOULEVARD, SUITE 5101 FALLS CHURCH, VIRGINIA
DEFENSE HEALTH AGENCY 7700 ARLINGTON BOULEVARD, SUITE 5101 FALLS CHURCH, VIRGINIA 22042-5101 NOTICE OF TRICARE PRIME AND TRICARE SELECT PLAN INFORMATION FOR CALENDAR YEAR 2018 Each year, the Defense Health
Special Bulletin. November Important FreedomBlue SM PPO and BlueRx SM PDP Changes for 2011
Special Bulletin Important FreedomBlue SM PPO and BlueRx SM PDP Changes for 2011 New Advanced Illness Services Program FreedomBlue HD (High Deductible Plan) Added FreedomBlue PFFS Eliminated Increases
ProviderNews. Discussing health issues with your patients. New mandatory generic policy for Medical record documentation standards FALL
ProviderNews FALL 2015 Discussing health issues with your patients Security Health Plan members may be asked to complete surveys regarding conversations they have had with their provider that are mandated
2018 Medicare Fact Sheet
2018 Medicare Fact Sheet L O C K T O N C O M P A N I E S MEDICARE COVERAGES Part A Part B Part C Part D Coverage for hospital Coverage for other Part C is called the Part D is an stays, skilled nursing
INTRODUCTION_final doc Revision Date: 1/1/2018 INTRODUCTION FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES
INTRODUCTION_final10312017.doc Revision Date: 1/1/2018 INTRODUCTION FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES Current Procedural Terminology (CPT) codes, descriptions and
Understanding the Insurance Process
Understanding the Insurance Process This summary provides an overview of the health insurance process. Health insurance falls into two major categories: commercial insurance and government insurance. Commercial
Table of Contents. Terms and Conditions of Participation... 5
Provider Guide Table of Contents Enrollment... 1 Eligibility Criteria... 1 Enrollment Periods... 2 Change of Membership Status... 2 Identification Card... 3 Customer Service... 4 Group Retiree Notification...