Professional Claim Form

Professional Claim Form Basics Professional Claim Form may be electronically submitted to a Medicare carrier, Durable Medical Equipment Medicare Administrative Contractor (DMEMAC), or A/B MAC from a provider’s office using a computer with software that meets electronic filing requirements as established by the HIPAA claim standard and by meeting CMS requirements contained in the provider enrollment & certification Read More →

Institutional Paper Claim Form

Institutional Paper Claim Form Guidelines Institutional Paper Claim Form (CMS-1450 form), aka UB-04 at present, can be used by an institutional provider to bill a Medicare fiscal intermediary (FI) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. It is also used for billing Read More →

Submitting HIPAA EDI Transactions

Submitting HIPAA EDI Transactions – Basic Procedures Submitting HIPAA EDI Transactions rules below are available for providers and their vendors who are interested in submitting HIPAA EDI transactions to HMSA for electronic claims submission, claims status, eligibility and referrals/pre-authorizations. The Electronic Trading Partner Agreement (TPA) must be signed and returned to HMSA before transactions can be submitted. The Read More →

EDI Medical UB-04

EDI Medical UB-04 Claims Procedures (Security Health Plan) EDI Medical UB-04 Claims processing procedures: EDI Medical UB-04 Claims completion for inpatient and outpatient services billed by hospitals, skilled nursing facilities, home health agencies and other institutional providers (Continuation). 66. Diagnosis code qualifier – This reflects which ICD-9 edition used – Not required. 67. Principal diagnosis code – The Read More →