Insurance and Claims
FOR 9 DIGITS US ZIP CODE
Rejection Message VALUE OF ELEMENT N403 IS INCORRECT. LAST 4 DIGITS SHOULD NOT BE '0000' OR '9999' FOR 9 DIGITS US ZIP CODE. SEGMENT N4 IS DEFINED IN THE GUIDELINE AT POSITION 0300. INVALID DATA xxxxx0000 Rejection Details This rejection indicates ...
Dependent : Entity not eligible
Rejection Message ACK/RETURNED - ENTITY NOT ELIGIBLE. USAGE: THIS CODE REQUIRES USE OF AN ENTITY CODE. - DEPENDENT Rejection Details Possible causes: The claim was submitted to the wrong payer ID. Note: This is the most likely cause if this rejection ...
Provider Contacts for Medicare and Medicaid Questions
Talk to someone | Medicare Claims & appeals | Medicare Coordination of Benefits. (medicare.gov) Medicare-Medicaid Coordination | CMS Provider Contacts for Medicare and Medicaid Questions (hhs.gov) Contacts Database | CMS
Procedure Modifiers
Practitioner Modifiers
Batch Billing
To save some time, Therasoft has allowed you to send your claims in batches, using the Ready to Bill Page (found under the insurance tab). On this page, you can select your date range and Therasoft will pull over all clients with attended sessions ...
How to Verify Eligibility and Benefits for Mental Health Providers [with Scripts]
Preparing To Check Eligibility and Benefits You’ll need to prepare a bit of information before you begin, so go make sure you’ve gathered: Provider information.. Your NPI number Your Tax ID or Employment Identification Number (EIN) or Social Security ...
Healthcare Insurance and Medical Specialties Glossary of Terms
Glossary Modern Healthcare is a complicated and oftentimes confusing business Whether it’s patient care jargon or health insurance plan language, it can all appear to be alphabet soup. So we thought we would alleviate some of the possible confusion ...
How to print the CMS 1500 claim form (aka drop to paper)
1. Go to Individual, Progress Notes and select the Client and DOS 2. Select the PRI button on the right side of the screen 3. Go to Insurance, View Claims 4. Select the New HCFA button 5. Select PlainPaper to download and print the form (Select ...
Medicare Beneficiary Identifiers (MBIs)
Medicare Beneficiary Identifiers (MBIs)We removed Social Security Number (SSN)-based Health Insurance Claim Numbers (HICNs) from Medicare cards and are now using Medicare Beneficiary Identifiers (MBIs) for Medicare transactions like billing, ...
Cigna Employee Assistance Program (EAP)
Employee Assistance Program (EAP) Employee Assistance Program (EAP) services are a separate and distinct benefit from an individual's behavioral health benefit plan. Some procedures that are offered through an individual's EAP may differ from ...
EOB Life Saver button
Gray: No EOBS. GREEN: EOB’s are ready to post. RED: Denied EOB’s -The denied eobs will stay red for 10 days to give you enough time to. Work the denied eobs, then you are able to change the date range if it is past the 10 days. ...
HCFA\CMS-1500 not aligning correctly
The system creates the CMS-1500 as a PDF to the exact dimensions of the claim form. If you are printing using the PrePrinted format onto a CMS-1500 claim form and it is not lining up properly, you will need to adjust your printer settings. ...
How to add and apply an insurance authorization
This can also be used to track EAP sessions if a certain number are free prior to needing an authorization. To add an authorization for the client it is a 2 step process. First, you must enter the Authorization for the client, and then you will need ...
Billing Add on Codes
1) Go to Setup, Session Catalog 2) Go to the Billing Code drop down box and select the Add-On CPT code you want to add from the list (example: 99354 or 99355) 3) Go to the Service Code field right above the Billing Code drop down and type in the ...
Secondary Insurance - How to bill
1. Go to Individual, Progress Notes and select the Client 2. Click Sec to the right of the first session 3. Select Original in the popup window 4. Click Sec, as needed, for any additional sessions 5. Go to Insurance, View Claims 6. Click on ...
Data Entry Locations for HCFA ID Numbers
What is the difference between Anthem Blue Cross and Blue Shield?
What is the difference between Anthem Blue Cross and Blue Shield? In California, Anthem Blue Cross and Blue Shield are actually different companies and are competitors. In most other states, they are the same company and formed an association, the ...
Emdeon Vision - Helpful Hints
HOW TO PULL UP AN EOB IN EMDEON VISION: - Login into Emdeon Vision - Click on Reporting & Analytics and then Claim Management - Click on Payments at the top - Select ERA Search - In the Time Period field, select the appropriate time range and clicked ...
What does EDI, ERA and EOB stand for?
EDI stands for Electronic Data Interchange and allows us to submit your claims electronically. ERA stands for Electronic Remittance Advice and allows us to post your EOBs electronically eliminating paper. EOB stands for Explanation of Benefits and ...
CMS 1500 Print Margin Settings
CMS-1500 Print Margin Settings Before you print a CMS-1500, you should ensure that your print margins are set to “none or zero” in your printer’s page setup or page settings. The reason your margins need to be set to none or zero is so the form fits ...
Adding New Insurance Carriers
The most important part of adding a new Insurance Carrier to your list is to first verify the Payer ID to be used through Change Healthcare. You can do a lookup using the following link but remember that you may not find it by name and may need to ...
Medicare 2021 Reimbursement Rates by CPT Code
CPT CODE DESCRIPTION MEDICARE REIMBURSEMENT RATE 2020 MEDICARE REIMBURSEMENT RATE 2021 90791 Psychological Diagnostic Evaluation $140.19 $180.75 90792 Psychological Diagnostic Evaluation with Medication Management $157.49 $201.68 90832 Individual ...
Using re-submission codes (HCFA 1500 claim form: Box 22)
Using re-submission codes (HCFA 1500 claim form: Box 22) This article will walk you through the process of editing a claim to show a specific re-submission code in Box 22 before refiling. The default setting for Box 22 on the HCFA 1500 form is ...
United Health Care, Optum, United Behavioral Health – What’s The Deal?
This short article will explain how these insurance companies relate, what questions to ask to make sure you're in network, and how to file claims. United Health Care (UHC), Optum, and United Behavioral Health (UBH) are all “Optum” companies which ...
UB-04/CMS-1450 Billing Codes
UB-04/CMS-1450 Reference Material Type of Bill Codes (Field 4) This is a three-digit code; each digit is defined below. UB-04/CMS-1450 Reference Material Type of Bill Codes (Field 4) This is a three-digit code; each digit is defined below. 1st ...
CPT Code 90847 & 90846: Couples and Family Therapy Billing Guide
CPT Code 90847 & 90846: Couples and Family Therapy Billing Guide CPT Code 90847 and procedure code 90846 can be challenging to bill. Here's a guide on how to bill mental health family therapy CPT codes 90847 and 90846. We will teach you the ...
Accept Assignment - CMS 1500 Box 27
What does Accept Assignment mean? The definition and use of Accept Assignment vary between payers, especially Medicare. However, the general definition states that: You indicate the case is assigned to you and that payment should be sent to you. You ...
MHN (Managed Health Network)Change in Corrected Claims
MHN (Managed Health Network) no longer accepts black and white corrected claims and views them as "handwritten." They require the red and white CMS-1500 forms with the number 7 (corrected claim) in Box 22.
Error message: "If you feel this code is an accurate icd10 billing code, and have checked this website https://www.icd10data.com/ and the code is correct, please call us at 888-435-8203, so we can add the code to our database."
Message received when attempting to submit a claim: "If you feel this code is an accurate icd10 billing code, and have checked this website https://www.icd10data.com/ and the code is correct, please call us at 888-435-8203, so we can add the code ...
Paper to electronic claim cross-reference guide
The following cross-reference guide for providers who submit electronic claim files. Field # Claim Description Loop Segment Electronic Description 1 Type of Health Insurance 2000B SBR01 Receiving Payer Responsibility (P = Primary, S = Secondary T = ...
Clearinghouse: Change Healthcare
Clearinghouse: Change Healthcare Therasoft works with our clearinghouse partner Change Healthcare to submit insurance claims and receive electronic remittance advice (ERA). Change Healthcare supports claim submission to over 2,000 payers nationwide, ...
Missing View Insurance button on Client Registration page?
1. Go to Insurance/View Clients 2. Click the Add New button at the bottom of the screen 3. Click the Client's name 4. Click OK to insert the record 5. Repeat steps until all client names are cleared from the list
Tricare North going to Tricare East.
Payer: 68299 - TRICARE EAST To: Change Healthcare Revenue Performance Advisor Customers Payer: 68299 - TRICARE EAST Dear Valued Customer, Please note the following Change Healthcare update regarding the Tricare announced consolidation of the ...
How to Send a Corrected Claim on Paper
1. Go to Individual, Progress Notes and select the Client 2. Click PRI to the right of the first session 3. Select Corrected in the popup window, enter the ID or Reference # that is printed on the paper EOB, then click OK to continue. 4. Click PRI, ...
Deleting or voiding an insurance claim
If you are needing to delete a claim, find the appointment on your calendar. 1. If the "I" button is green, there is no way to stop the claim. You will need to call the insurance company and explain to them what happened. 2. If the "I" button is ...
Missing EOBS/ERA
If you are finding that you are missing an era/eob then here is what we need you to do. 1. Contact the payer and ask to speak to the EDI department, ask them if they still have Change Healthcare as the clearinghouse to send the era files on record, ...
How do I add new CPT Codes?
1) Go to Setup, Session Catalog 2) Select the CPT Code from the Billing Code drop down 3) Enter this CPT Code into the Service Code 4) Enter the Description (ex. Ind. Therapy) NOTE: If you use the same code with different billing units or different ...
Common claim rejections: What they mean and what actions you should take
Rejection Message Rejection Clarification Action Items Claim Frequency Code Information submitted inconsistent with billing guidelines. Payer Assigned Claim Control Number. The Payer has rejected the claim because the frequency code used with the ...
Proof of Timely Filing Letter - Insurance
To obtain a letter of Proof of Timely Filing: 1) Login to your change healthcare account 2) Click on Reporting and Analytics on the left 3) Click on Claim Management 4) Claims and then patient search 5) Find the patient and date of service you are ...
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