[PDF] Top 20 Provider Manual. Billing and Payment

... Depending on the benefit plan, Kaiser Permanente Members may be responsible to share some cost of the services provided. Copayment, co- insurance and deductible (collectively, “Member Cost Share”) are the fees a Member ... See full document

... (100%) payment quality but recognizes that a small percent of financial overpayments will occur while processing ...inappropriate payment caused an overpayment, WellCare will limit its recovery effort to ... See full document

... All pregnant women with Medicaid can benefit from “enriched” maternity services regardless of risk status. We ask that you provide the scope of service appropriate to the woman’s individual level of need. Documentation ... See full document

... Depending on the terms of your Agreement, you may not be compensated for Services directly related to any Do Not Bill Event (as defined below) and may be required to waive Member Cost Share associated with, and hold ... See full document

... A physician who is concurrently directing the administration of anesthesia to not more than four surgical patients cannot ordinarily be involved in furnishing additional services to other patients. However, addressing an ... See full document

... they need to hang tight in the line for longer time. The thought which is proposed utilizing RFID innovation will conquer the issue and it gets the undertaking less demanding. The joined impacts of simple and adaptable ... See full document

... Gundersen Health Plan maintains a right of subrogation when claims have been paid for which a third party is liable, i.e. accidents on private property, motor vehicle accidents, and non-work related injuries. Gundersen ... See full document

... (100%) payment quality but recognizes that a small percent of financial overpayments will occur while processing ...inappropriate payment caused an overpayment, WellCare will limit its recovery effort to ... See full document

... of Payment (EOP) be submitted with a claim in order to coordinate SCHA member ...insurance payment or denial date, or within 180 days from the date of service, whichever is ... See full document

... such provider. If a provider has satisfied the requirements described in paragraphs (1) through (6) of this subdivision, no repayment will be required if the provider can produce documentation ... See full document

... individual provider or electronic biller (the billing agent) receives a remittance advice (RA) for services that are ...the provider of the action taken on ...the Billing and Reimbursement for ... See full document

... The “Provider Self-Service” feature of the website is the primary search tool available to Network Providers. The data is updated frequently to ensure providers have access to the most accurate information ... See full document

... Network/Participating Provider will make available suitable work space for Plan’s on-site Audit ...Network/Participating Provider will give Plan or its designee a complete list of credit balances for ... See full document

... It is APS policy to adhere to our client’s non-waiver of co-payment guidelines. As such, APS will not waive a member’s co-payment or coinsurance responsibility under any circumstances. We subscribe to the ... See full document

... paper billing form is able to accommodate the reporting of the National Provider Identifier (NPI) ...single provider identifier, replacing the different provider identifiers health care ... See full document

... CountyCare takes the detection, investigation, and prosecution of fraud and abuse very seriously, and has a waste, abuse, and fraud (WAF) program that complies with Illinois and federal laws. CountyCare, in conjunction ... See full document

... of Billing Agents or persons par@cipa@ng in the prepara@on of a Medicaid claim shall not be based on amounts for which they bill nor based on the amount a provider receives from the Medicaid ... See full document

... Survey Provider Enhanced Reporting (CASPER) ...and provider validation reports, which would disclose SNFs’ data submission status, providing details on all items submitted for a selected assessment and the ... See full document

... If services are provided to a Member/plan participant prior to receiving a written referral, it is your responsibility to obtain the written referral from the Medical Group physician before billing for such ... See full document

... If billing for services that have been referred to more than one laboratory, the referring laboratory shall submit a separate claim for each laboratory to which services were referred (unless one or more of the ... See full document