Hospice
All hospice claims are considered which type of claim (I/O)?
Outpatient
Outpatient dialysis bill type is what?
72X
The health plan will pay up to how many hours of observation without an authorization?
24 hrs
Which bill type is used for claims with zero billed charges, non-covered services, or claims that cannot be paid?
All vaccination CPT/HCPCS codes are required to be billed with what?
NDC code, quantity, and qualifier
Is an admit date required for this type of claim?
Yes
If you have admit type 9, it must correspond with what else?
Admit source 9
Outpatient hospital bill types include which ranges? (name 2)
130-139, 850-859, 140-149
For bill type 130's that are RHC's (that bill on UB-04s), idx will auto deny these as dispo 535 - missing/invalid box 19. This will need to be changed to which dispo?
194 or 82 (resubmit on cms-1500 version 02/12)
J7999 is a procedure code that is used for what kind of drugs?
Compounded drugs
Valid hospice bill types begin with what?
What range of condition codes must be in the first condition code field in IDX?
If a member visits the same outpatient facility more than once on the same DOS, which condition code is required on each subsequent visit?
G0
All COVID-19 vaccinations must be reported using which admin code?
90480
What is the max number of visits for each type of PT? (does not include Inpatient facility therapy or OP wound care)
15
The patient reason for visit dx but support what conditions that are consistent with hospice elections?
terminal conditions
Which condition code (which differentiates ESRD claims from AKI claims) can be billed by itself (without any 70-79 condition codes)?
84
Medicare Part B deductible would be entered in as which value code on pg. 3 in IDX?
B1
All unlisted procedure codes require what to be valid?
A description (written, NDC, authorization)
If a vaccine antigen is billed without an administration code, you would deny the antigen with which dispo?
868 - admin code required
Which part of CMS (Medicare) covers hospice?
Part A
Dialysis claims are typicall reimbursed using the AHCCCS Dialysis Fee for Service Rates and Codes Schedule. Name two of the providers that have their own contracted rate?
DaVita and BMA
Revenue codes that require HCPCS codes can be verified via the BUHP portal under monthly facility claims reference files - which report?
Rev Code to Bill Type
Which procedure code requires special processing guidelines that apply to members receiving speech therapy who are members of AzEIP?
92507
If a vaccine administration code is billed without the vaccine antigen code, deny the administration code with which dispo?
550 - bill antigen codes