Claim Filing Indicator Code For Medicare Advantage

BCBSA An acronym for Blue Cross Blue Shield Association. Remark codes based on the exception codes posted to the claim.

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Claim filing indicator code for medicare advantage. ASC X12 Claim Filing Indicator CFI Mapped to Source of Payment Typology Version 70 Claim Filing Indicator Source of Payment Typology Version 70 Code Description Code Description 09 Self-Pay 8 No Payment 11 Other Non-Federal Programs 3 4 9 Other Government Department of Corrections MiscellaneousOther. Use claim filing indicator code 16 for Medicare HMOAdvantage Plan. 4 There must be an Other Payer header detail screen completed for every crossover claim format.

Data Element Table 10 837 Professional Transaction Sample 15. SBR09MB on 837P or SBR09MA on 837I must be used when reporting this type coverage. ALL claims filed with file extensions XXA or XXB MUST be for recipients with Medicare Advantage coverage.

The information in this handbook is based on the Code of Alabama 1975 Title 16. The claim filing indicator located in Loop 2320 segment SBR09 identifies whether the primary payer is Medicare or another commercial payer. Complete all other fields as you normally would On the Srv 3 screen make sure that the Service Adjustment Ind field is Y this will display the Srv Adj screen for the detail that you are completing.

3 The filing indicator for Medicare AdvantagePart C crossover claims is 16 followed by the appropriate claim type. 5 Medicare AdvantagePart C institutional claims need only the Other Payer header detail. Medicare Claims Processing Manual CMS.

Providers need to use a value of MA to identify Medicare Advantage claims in Loop 2320 Segment SBR09. Use adjustment reason codes 1 for deductible enter amount of deductible in the next field 2 for coinsurance and lifetime reserve day responsibility enter coinsurance LTR amt. This transferreadmit indicator is present on the internal episode file used in CWF.

The code indicating the record version of the Nearline file where the institutional carrier or DMERC claims data are stored. For additional information refer to the MLN Matters article. Medicare Part B.

Note that the term final action is used differently in encounter data compared to fee-for-service. Claim Filing Indicator Code 8. Please ensure you are using the appropriate indicator on EDI claims.

2320 SBR09 Claim Filing Indicator Code segments created to qualify other supplemental payers included in 2330B will also contain CI in accordance with the COBA ID ranges 00001--69999 and 80000-89999. This provides information that pertains to the whole claim. Mid-Level Practitioners serving Medicare Advantage members can file claims and be paid under BCBSNC Companion Guide to X12 5010 transactions 837 Professional Health Care Claim V5 2.

Reporting 8 Modifying Erred Claims 9. BCBSM or FEP Supplemental BCBSM or FEP is being billed as the secondary payer and the primary payer is original Medicare or any type of Medicare Advantage or Medicare Advantage HMO. BCBSNC Business Edits for Senior Market Health Care Claim 21.

X12N005010X222 837 Professional Health Care Claim transaction format. When the member has a Medicare Advantage plan the claim should be billed to the secondary payer with a Medicare Part A or B indicator not as commercial insurance. The various levels of testing will check for X12 standard code.

The Loop 2320 SBR09 Segment when reporting the Medicare Advantage coverage causes claim file rejections. This field is stored in the CMS Integrated Data Repository IDR as the final action indicator. Other commercial third party coverage may also be reported for the recipient.

Loop with Medicare information is allowed. The MA in the suitcase indicates a member who is covered under the Medicare Advantage PPO network sharing program. Payer Paid Amount at claim.

A non-payment code Z will display in the NPC field on the Claim Summary Inquiry screen MAP1741. Also complete the Paid DateAmount fields. Effective January 5 2015 home health requests for anticipated payment RAPs with a From date that falls within a Medicare Advantage plan enrollment period will be processed P B9997 with no payment.

The Submitter Name in Loop 1000A Segment NM103 ADVANTAGEMEDICARE-PART-C should be used for 837I claims. Claim filing indicator for medicare. CMS Medicare Carrier File Documentation.

Medicare Claims Processing Manual CMS. 2091 Correct. Edits and Reports 8.

The PEEHIP Group Medicare Advantage PPO Plan as of 112020. As with other Blue Cross products members should provide their ID cards. Use claim filing indicator code MB for Medicare B and 16 for the Medicare HMOAdvantage plan.

Beginning on and after January 1 2020 the original HH PPS system is. Business Scenario 15 Data String Example 15 837 Professional File Map 17. BCBSNC Business Edits for the 837 Health Care Claim 19 Appendix B.

Member Handbook 2019-2020 Retirement Systems of Alabama. Electronic claim submission use the paper Form CMS-1450 also. Complete the Policy Holder Information using the correct carrier code for the plan.

However CMS has verified that for 2015 encounter records this field should not be used to identify the final version of the record.

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