Individual provider numbers must be provided in the spaces provided on the MA 307. Found insideOCTOBER 1968 PENNSYLVANIA PROVIDER ADDRESS ZIP BLAIR CHEMICAL LABORATORIES HITE CLINICAL LABORATORY 2714 OAK AVE 3025 BROAD AVE ALTOONA PENNSYLVANIA 16603 ... Is there a revenue code table for inpatient and outpatient? Found insideOCTOBER 1969 PENNSYLVANIA PROVIDER ADDRESS ZIP HOME STEAD PENNSYLVANIA 15120 HOMESTEAD HOSP - HOME CARE PROG 1800 WEST ST HONESDALE PENNSYLVANIA 18431 WAYNE ... Select a value from the, drop-down box. Select the other insurance code from the drop-down list, or enter an appropriate value as specified: Crossover Indicator - Used to activate the Crossover screen, which is used to record a recipient's Medicare information. Please inform the PSR Representative that you are calling to request PROMISe™ training. Camp Hill, PA 17089-0062 Highmark Blue Shield Indemnity Major Medical Highmark Major Medical P.O. The charges may be billed on the PROMISe™ Provider portal using the institutional claim form, on the UB-04 paper claim form or via Provider Electronic Solutions (PES) or other third-party software. Nursing, technician and related services; Drugs, biological, surgical dressings, supplies, splints, casts and appliances and equipment directly related to the provision of surgical procedures; Administrative, recordkeeping and housekeeping items and services; The ASC or SPU shall submit invoices to DHS in accordance with the instructions in the Provider Handbook. When the MA-307 is used, claims must be separated and batched according to the individual provider who rendered the services. How should immunizations for EPSDT screens be reported on the CMS-1500 claim form?Please refer to the EPSDT Billing Guide and the EPSDT Periodicity Schedule and Coding Matrix (both documents are PDF downloads). Physicians are required to use the 11-digit National Drug Code (NDC) and assign a prescription number for the medication. Up to eleven additional adjustments can be added. Found inside – Page 31OMS selected Pennsylvania Blue Shield to operate the pilot project for two ... Postage costs associated with Part A Medicare claims ( hospital services ) ... The original claim must be received by the department within a maximum of 180 days after the date the services were rendered or compensable items provided. Found inside – Page 108Page 002 of 003 Your Medicare number is : :: out this notice ces and Service ... you may write to us at the following address : Pennsylvania Blue Shield ... Enter the mother's name, social security number, and date of birth on the 8½ by 11 sheet of paper. When the MA-307 is used, claims must be separated and batched according to the individual provider who rendered the services. The medical license number must be used when. on the claim form or must retain the recipient's signature on file using the Encounter Form (MA 91). Line B- MAPA (represents Medical Assistance), Blocks 2 (Patient's Name (Last Name, First Name, and Middle Initial) and 3 (Patient's Birth Date) -, Block 19 (Reserved for Local Use) - Enter Attachment Type Codes AT26 (which indicates that you are billing for a newborn using the mother's ID number) and AT99 (which indicates that you have an 8½ by 11 sheet of paper attached to the claim form). Develop a skilled workforce that meets the needs of Pennsylvania's business community, Provide universal access to high-quality early childhood education, Provide high-quality supports and protections to vulnerable Pennsylvanians. 0 Attention: Claims Department 2020 Technology Parkway, Suite 100 Mechanicsburg, PA 17050: Connecticut Does PROMISe™ accept the MD license number or the UPIN number for the physician format?Medical Assistance does not accept UPINs on any claim submission media. 15. Enter the amount of the adjustment for this claim in the Amount box at the end of the Adjustment 1 row. If submitting electronically, use the reason code from the EOB or 835 in the appropriate TPL loops. 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. How do I submit claim adjustments on PROMISe™?The Provider Claim Inquiry window is used to make an adjustment to a claim on PROMISe™. on with your unique user ID, challenge question answer and password, click on the Claims tab, then Submit Professional. P.O. Effective January 1, 2012, ALL providers including Waiver providers must report a diagnosis code when submitting the following claim types: laim adjustments may be submitted electronically via the 837 claim transaction and on the PROMISe™ Provider Portal. When billing for services provided to a recipient who is unable to sign because of a physical condition such as palsy. Found inside – Page 1-4Pennsylvania Blue Shield. 1.4 Addresses This section contains the addresses for submitting initial claims , appeals , general inquiries , etc. Please review this section carefully to assure that you are submitting your inquiries to the ... The MA 307 must be submitted with the corresponding batches of individual provider's claims (maximum of 100 invoices per transmittal). For second digit bill classification, do we use a "4" when we bill for special treatment room "X" codes? If the MA-307 is used, a handwritten signature or signature stamp of a Service Bureau representative, the provider, or his/her designee must appear on the MA-307. Are emergency room services still billed with "W" codes?No, refer to Medical Assistance Bulletin 01-06-05 and the outpatient fee schedule for the correct codes. endstream endobj startxref You can perform a search only for claims submitted by your provider number and service location(s). Note that all ICNs and Recipient IDs are hyperlinked. Found inside – Page 89Firm Name : Medicare Name : Address : Aetna Health Plans of Western PA , Inc. Aetna Medicare Program 5700 Corporate Drive , Suite 300 Pittsburgh , PA 15237 ... 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. Jurisdiction H (JH): Novitas Solutions Attn: Part A Claims PO Box XXXX (replace the X's with the PO Box number from the table below) Mechanicsburg, PA 17055-XXXX (fill in the +4 from the table below) 19. You will see a hyperlink for Facility Provider Numbers and clicking the hyperlink will allow you to view a list of provider numbers for Acute Care Hospitals, Ambulatory Surgical Centers, Psych and Rehab Hospitals and Short Procedure Units. For additional information, please refer to the DHS website for information on Pharmacy Services or PROMISe Provider Handbooks and Billing Guides. 16. 12. Claims Submission Address . The charges may be billed on the PROMISe™ Provider portal using the institutional claim form, on the UB-04 paper claim form or via Provider Electronic Solutions (PES) or other third-party software. PA Health & Wellness . Scroll down the claim window to the, drop-down box. 2. Box 8025Harrisburg, PA 17105-8025. You will see a hyperlink for Facility Provider Numbers and clicking the hyperlink will allow you to view a list of provider numbers for Acute Care Hospitals, Ambulatory Surgical Centers, Psych and Rehab Hospitals and Short Procedure Units. What are the options for submitting claims electronically?Providers may submit electronic 837 claim transactions through clearinghouses and certified third-party software. Regardless of submission media, you can retrieve all claims associated with your provider number. Found inside – Page 69PENNSYLVANIA Firm Name : Medicare Name : Address : Telephone : Counties : Aetna Health Plans of Central & Eastern PA Senior Choice 955 Chesterbrook ... There is a PROMISe™ Companion Guide for each transaction set available at: ou submit claims using the Provider Electronic Solutions (PES) software, the user manual located, If you submit claims via the PROMISe™ Provider Portal, the user manual located, You may request training by contacting the Provider Service Center at. The MA 307 must be submitted with the corresponding batches of individual provider's claims (maximum of 100 invoices per transmittal). Table H1: Claim Addresses Claim Type Address UPMC Health Plan (Commercial) UPMC Health Plan PO Box 2999 Pittsburgh, PA 15230-2999 UPMC for Kids (CHIP) UPMC for Kids PO Box 2999 Pittsburgh, PA 15230-2999 UPMC for Life (Medicare) coinsurance. If the MA-307 is used, a handwritten signature or signature stamp of a Service Bureau representative, the provider, or his/her designee must appear on the MA-307. If you submit claims through a clearinghouse, you are covered under the clearinghouse's certification. Are "J" codes compensable under Medical Assistance?No, "J" codes are not compensable under Medical Assistance. Providers may submit Medicare Summary notices or other remittance if applicable to: A claim which has been submitted to the department not appearing on a piece of remittance advice within 45 days following that submission, should be resubmitted by the provider. If you submit claims via the PROMISe™ Provider Portal, the user manual located here will assist you with your claim submissions. In this instance, you must obtain the recipient's signature on the Encounter Form (MA 91). 1. 1. Can we bill for services provided to a newborn using the mother's Recipient ID number?Yes. There is no reimbursement to a physician for medical supplies or equipment dispensed in the course of an office or home visit. Found inside – Page 133STREET ADDRESS CITY , STATE , ZIP OWNERSHIP FACILITY TYPE NETWORK SERVICES PHONE UNIV OF PA OUTPATIENT DIALYSIS 4126-38 WALNUT ST PHILADELPHIA , PA 19104 ... 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