For proper payment and application of deductibles and coinsurance, it is important to accurately code all diagnoses and services (according to national coding guidelines). It is particularly important to accurately code because a
member’s level of coverage under his or her benefit plan may vary for different services. You must submit a claim for your services, regardless of whether you have collected the copayment, deductible or coinsurance from the member at
the time of service.
To assist you in understanding how your claims will be paid, UnitedHealthcare’s Claim Estimator includes a feature called Professional Claim Bundling Logic which helps you determine allowable bundling logic and other claims
processing edits for a variety of CPT (CPT is a registered trademark of the American Medical Association) and HCPCS procedure codes. Note: Only bundling logic and other claims processing edits are available under this option.
Pricing and payment calculations are not included.
Allow enough time for your claims to process before sending second submissions or tracers, then check their status online at UnitedHealthcareOnline.com. If you do need to submit second submissions or tracers, be sure to submit them
electronically no sooner than forty-five (45) days after original submission.
Complete claims include the information listed under the Complete Claims Requirements section of this Guide.
We may require additional information for particular types of services, or based on particular circumstances or state requirements. If you have questions about submitting claims to us, please contact Customer Care at the phone number listed on the member’s health care ID card.
Complete claims requirements
• Member’s name
• Member’s address
• Member’s gender
• Member’s date of birth (dd/mm/yyyy)
• Member’s relationship to subscriber
• Subscriber’s name (enter exactly as it appears on the member’s health care ID card)
• Subscriber’s ID number
• Subscriber’s employer group name
• Subscriber’s employer group number
• Rendering Physician, Health Care Professional, or Facility Name
• Rendering Physician, Health Care Professional, or Facility Representative’s Signature
• Address where service was rendered
• Physician, Health Care Professional, or Facility “remit to” address
• Phone number of Physician, Health Care Professional, or Facility performing the service (provide this information
in a manner consistent with how that information is presented in your agreement with us)
• Physician’s, Health Care Professional’s, or Facility’s National Provider Identifier (NPI) and federal Tax Identification Number (TIN)
• Referring physician’s name and TIN (if applicable)
• Date of service(s)
• Place of service(s) (for more information see: cms.hhs.gov/PlaceofServiceCodes/Downloads/placeofservice.pdf)
• Number of services (day/units) rendered
• Current CPT-4 and HCPCS procedure codes, with modifiers where appropriate
• Current ICD-9-CM (or its successor) diagnostic codes by specific service code to the highest level of specificity (it is essential to communicate the primary diagnosis for the service performed, especially if more than one diagnosis is
related to a line item)
• Charges per service and total charges
• Detailed information about other insurance coverage
• Information regarding job-related, auto or accident information, if available
• Retail purchase cost or a cumulative retail rental cost for DME greater than $1,000
• Current NDC (National Drug Code) 11-digit number for all claims submitted with drug codes. The NDC number must be entered in the 24D field of the CMS-1500 Form or the LIN03 segment of the HIPAA 837 Professional
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
CPT CODE and description 90460 - Immunization administration through 18 years of age via any route of administration, with counseling by ...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
CPT CODE and Description 97001 - Physical therapy evaluation Average fee payment $70 - $80 97002 - Physical therapy re-evaluation Ave...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
CPT CODE and Description 90785 - Interactive complexity (List separately in addition to the code for primary procedure) 90791 - Psychi...
Here is the big list of Medical terminology abbreviation @—at A & P—anatomy and physiology ab—abortion abd—abdominal ABG—arterial ...
Place of Service: A two-digit code used on health care professional claims to indicate the setting in which a service was provided. Place...
Complete Blood Count (CBC) Testing A complete blood count consists of measuring a blood specimen for levels of hemoglobin, hematocrit, red...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...