Author Topic: 1500 CMC form  (Read 3652 times)

gderilus

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1500 CMC form
« on: January 12, 2010, 09:16:48 PM »
I have a question regarding the claim form. I'm billing for a mental health provider and she was the only provider in the office. Now she has another provider coming in the office and they going to have 60/40 split for all AR. She will still be the billing provider meaning all the check would come under her name. My question is, would the new provider need to be in network with the insurance companies also in order to bill them or can I just put him down as the rendering provider and my provider would be the billing provider.

Michele

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Re: 1500 CMC form
« Reply #1 on: January 13, 2010, 10:04:29 AM »
The new provider must be credentialed with all insurance carriers.  When that is done they need to indicate that they will be working for the first provider, and that they are assigning all payments to be made to that provider.  Then they would be listed on the claim as the rendering provider, and the first providers billing info would be in box 25 and 33.

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Meli

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  • Melissa Turner
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Re: 1500 CMC form
« Reply #2 on: January 22, 2010, 11:30:47 AM »
Hi Michele,

Since this provider will be working for the original does that make it not necessary to have a group NPI?  If they decide to partner or bill individually a group NPI will be needed at that time?

Melissa
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gderilus

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Re: 1500 CMC form
« Reply #3 on: January 22, 2010, 01:52:14 PM »
I also have a few more questions, I'm new to billing and very confused. When the patient comes in and pay their copay, when you sending the claim to the insurance do you put the amount they pay in the claim also and put the charge for the service date, or do you just put the charge only not the copay.

Pay_My_Claims

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Re: 1500 CMC form
« Reply #4 on: January 22, 2010, 06:46:00 PM »
u have to post copay

gderilus

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Re: 1500 CMC form
« Reply #5 on: January 22, 2010, 06:47:46 PM »
u mean post copay on the cms 1500 form right

Michele

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Re: 1500 CMC form
« Reply #6 on: January 25, 2010, 07:23:07 AM »
As for the group NPI, it depends on if the provider (employer) bills using a legal business name and EIN/TAX ID number.  If they do, then a group NPI is needed.  If they bill under their name & ss # then only an individual.

As for the copay, you certainly must post it on the system, however, we have been advised by a MAJOR commercial carrier it is best NOT to report any patient payments on the claim form.  They told us that it messes things up.  You should always report the actual charges (NOT the charge minus any payment).  Personally, I feel that you should report the patient payment as well, but I thought I would share what we had been told.

Michele
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Meli

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  • Melissa Turner
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Re: 1500 CMC form
« Reply #7 on: January 26, 2010, 10:38:56 AM »
Thanks for sharing that Michele,

I always thought we were to report what the patient paid also.  It seems we are not being honest if we don't however looking at  claims submitted it always shows the amount billed not subtracting what was paid.  Now I'm going, hmmmmmm ???  LOL

Melissa
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PMRNC

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Re: 1500 CMC form
« Reply #8 on: January 26, 2010, 11:24:38 AM »
As somoene who spent quite a few years as a claims examiner, we really never looked at the "Pmt" box, but for any carrier to tell you NOT to does not make sense. That box if filled in and if pmt to provider is more than full fee will tag an alert to the examiner to check for assignment of benefits. So for example, let's say you submit a charge for an office visit $100.00 and the patient paid $20. You report the full charge and the copay is posted. Let's say the copay should only have been $10? Claim edits will alert the examiner but if there is an assignment of benefits the check will go to the provider and a note/tag will go into the file just in case a patient needs help in reclaiming that $10.  So I have no idea why any carrier would say NOT to fill it in. I worked for Prudential, BCBS, USLife (now AGI) and briefly at Cigna. All carriers have basically an identical system in place for claims processing.
Linda Walker
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Michele

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Re: 1500 CMC form
« Reply #9 on: January 26, 2010, 09:00:16 PM »
Well, as I said I personally don't agree, but it was BCBS that advised us, and many other providers at a seminar, not to include any payments on the CMS form.  Doesn't really make sense to me either, and we expressed our concern to them, but didn't get anywhere.

Michele
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PMRNC

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Re: 1500 CMC form
« Reply #10 on: January 26, 2010, 09:03:40 PM »
Is it an "edit"? or was this just something they said was not "advisable"?  what happens if you put the payment?? Is this for NY? I am in NY and bill a variety of BCBS  (Empire, WNY, ...) and I've always posted my payments.
Linda Walker
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Michele

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Re: 1500 CMC form
« Reply #11 on: January 26, 2010, 09:49:57 PM »
It was our local BCBS.  They said that it 'messed up' their processing system.  Personally, I think they have other issues with their processing system.  I wonder if the higher ups know what they tell people at these seminars.

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PMRNC

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Re: 1500 CMC form
« Reply #12 on: January 27, 2010, 02:22:30 PM »
Not meaning to sound like I'm beating a dead horse..but ok.. what happens if you do put the payment on the claim form. I ask because I'm in NY too and I've never had a claim rejected over that.
Linda Walker
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Michele

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Re: 1500 CMC form
« Reply #13 on: January 28, 2010, 07:08:39 AM »
Well, we actually submit electronically to that company and our electronic software doesn't include the patient payment info on claims.  It only includes payment info when submitting secondary claims.  However, we are in the process of switching to Xena and I'm not sure if that will change.  We have never gotten a rejection for it, nor have we heard of anyone else getting one, but I'm not sure we've ever submitted a claim showing a patient payment. I still remember when they told us.  Our jaws were hanging down.  How can showing that a patient with a $20 copay, making a $20 payment mess up your processing system?????

I knew when I put it that it would stir something up.  I just wanted to show that sometimes insurance carriers request things that don't make sense.  Messes with people like us who keep all things in order!

Michele
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Pay_My_Claims

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Re: 1500 CMC form
« Reply #14 on: January 28, 2010, 05:02:51 PM »
It has NEVER messed up the billing for me and I have been doing NC BCBS for years. If you look at the CMS-1500 and they are processing the claims, they are not pulling "amount due" they look at the total charges, and pay according to their contracted fee. This is why some patients get refunds because providers may collect the wrong amount up front. When billing 2ndary they want the EOB to see what was paid by the primary to do that reduction from what they allow and what they pay..this is why sometimes you can have a secondary payment come in and it pays more than what the balance is. They are not looking at that column. NC medicaid prime example we can't put on the claim the balance, we can only put on the claim the cost share when a Medicare HMO is primary, and those claims can only be done paper.