Friday, April 8, 2011

checking claims status through IVR

DME MAC A IVR User Guide - Claims Options

Claims - Option 1

When the claims option is selected, the IVR will request the following elements:

• National Provider Identifier (NPI)
• PTAN (10-digit supplier number)
• Last 5 digits of the Tax Identification Number (TIN)
• Beneficiary Medicare number
• Beneficiary first and last name (last name and first initial if using touch-tone)
• Date of service
Once the authentication elements have been verified, the IVR will supply the following, if applicable:
• Total number of claims located for the specified Medicare number/date of service
• Claim status
• Submitted amount
• Allowed amount
• Amount applied to deductible
• Payment amount
• Payment date
• Check number

For additional claim information, say Claim Details (touch-tone 4) to obtain the following, if applicable:

• Additional Documentation Request (ADR) dates
• Claim Control Number (CCN)
• Total number of line items
• Line Item information
o Date of service
o Submitted amount
o Allowed amount
o Procedure code
o Modifier
o ICD-9 Diagnosis
o Denial reason

• Ability to order duplicate remittance
If multiple claims are located, say Next Claim (touch-tone 2) to move to the next claim or say Previous
Claim (touch-tone 3) to move back to the previous claim. For additional claims navigation options, please
refer to the following:

                         Claims  Navigation
Voice                                                    Touch-Tone Entry
Repeat That                                                               1
Next Claim                                                                2
Previous Claim                                                          3
Claim Details                                                             4
Duplicate Remittance                                                 5
Change Date                                                             6
Change Medicare Number                                        7
Change PTAN                                                          8
Main Menu                                                               9


Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.

Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)

Medicare Physician Fee Schedule Payment Rates Formula

The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +

Medicare fee schedule download