Medicare & Medicaid

Follow the provided links for more information relating to Medicare & Medicaid. We have compiled several important online resources that can help keep you current and up to date on important topics.

• Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)
• Medicare Administrative Contractor (MAC) Transition and Outbound Health Insurance Portability and Accountability Act (HIPAA) Transactions
• Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
• Intermediary Carrier Directory - Centers for Medicare and Medicaid Services

ABN: Claims with incorrect ICD-9 codes:

• Medicare National Coverage Determinations (NDC) Coding Policy Manual and  Report April, 2010
• Medicare Place of Service Codes
• Clinical Laboratory Management Publication
• Understanding The Remittance Advice: A guide for Medicare Providers, Physicians, Suppliers and Billers
• Medicare Clinical Labs Center

Useful Links and Tools

• Quarterly Update to Correct Coding Initiative (CCI) Edits
• Palmetto GBA More than just Medicare
• Noridian Medicare
• TrailBlazers Medicare Part B
• NHIC Corp a CMS Contractor
• Service Place Codes
• Modifiers
• Instructions Regarding Processing Claims Rejecting for Gender/Procedure Conflict
• Validating the Billing of End Stage Renal Disease (ESRD) 50/50 Rule Modifier

Eligibility:

• CHAMPUS
• Blue Cross Blue Shield of CA
• GHI
• Cigna