All of the following procedures and services require Prior Plan Notification and must be provided in a SHP participating facility*:
o Inpatient and Observation Admissions, as noted above
o Admission to any rehabilitation and skilled nursing facility
o All surgical procedures, inpatient or outpatient
o The following have special reporting requirements (refer to Forms Section):
* Abortions
* Hysterectomies
* Sterilization procedures
o Cosmetic or Reconstructive Surgery, including but not limited to:
* Breast reconstruction or reduction
* Blepharoplasty
* Venous procedures
* Sclerotherapy
o Services and items:
* Allergy (immunotherapy), exept for those services identified on the QAF
* Ambulance transportation (non emergent)
* Amniocentesis
* Cardiac and pulmonary rehabilitation programs
* Circumcisions after 12 weeks of age
* Court-ordered services
* Chemotherapy
* Dialysis
* DME, including apnea monitors and bili-blankets
* Upper endoscopies at colonoscopies at hospitals
* Genetic testing
* Gamma Knife, Cyberknife
* Hearing aids
* Home Health Services
* Hospice care
* Hyperbaric Oxygen Therapy (HBO)
* Investigational and experimental procedures and treatments
* IV Infusions
* Laboratory services in POS 22 and 24
* Lithotripsy
* Mental Health (See Mental Health Section)
* Nutritional counseling
* MRI’s, MRA’s
* Oral Surgery
* Oxygen therapy and equipment
* Out-of-Network Services
* Pain Management and or Pain Injections
* PET Scans
* Prenatal care
* Orthotics and Prosthetics, including Cranial Orthotics
* Physical, Occupational and Speech Therapy
* Radiation therapy
* SPECT scans
* Transplants and pre and post transplant evaluations
* Wound Care and wound vacuums
* Drugs that require pre-authorization
* Any services or procedures not listed on the Quick Authorization Form (QAF)
*Unless the service is only available in a non-participating facility.
Learn Medical Billing Process, Tips to best AR Specialist. Medical Insurance Billing codes, Denial, procedure code and ICD 10, coverage guidelines. Demographic, charge, payment entry, AR process and eligibility and follow up. How to Guide.
Pages
- Home
- Medical Billing Question and Answer - Terms
- Insurance Denial Claim Appeal Guidelines.
- Medical Billing Downloads
- Understand Medical Billing
- Medical Billing Outsource
- Medicare Coverage and Plan Overview
- Advertise with us
- EVALUATION AND MANAGEMENT CPT code [99201-99499] - Full List
- Overall Medical billing process
- CPT Code 99201, 99202, 99203, 99204, 99205 - Which code to USE
- Internal Medical Billing Audit - how to do

Subscribe to:
Post Comments (Atom)
Medical Billing Popular Articles
-
CPT CODE AND Description 99391 - Periodic comprehensive preventive medicine reevaluation and management of an individual including an age...
-
Procedure CODES and Descriptions 99401 - Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an indi...
-
CPT Code and description 99381 - Initial comprehensive preventive medicine evaluation and management of an individual including an age an...
-
When an ERA is received, providers may: •Post decision and payment information automatically, for individual claims included in an R...
-
Procedure code and Description 99251 Inpatient consultation for a new or established patient, which requires these 3 key components: A pro...
-
CPT code and description 80050 - General health panel This panel must include the following: Comprehensive metabolic panel (80053), ...
-
Medicare denial code and Descripiton 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent ...
-
93000-93010: Hone Your ECG Coding Skills With 3 Essential Pointers Whether you call them ECGs or EKGs, chances are you see a lot of elec...
-
Background: Type of Service (TOS) is an indicator that the contractor places on the Form CMS-1500 paper form or electronic format. The indic...
-
Billed amount: It is the Amount charged for each service performed by the provider. In other words it is the total charge value of the cla...

1 comment:
Thanks for such a wonderfull information, These kind of post are always inspiring and I prefer to read quality content so I happy to find many good point here in the post, writing is simply great, thank you for the post,..one more link for local medical billing company
Post a Comment