Wednesday, February 2, 2011

How to attach the documents properly with CMS 1500

Paper Claims with Attachments 

When submitting attachments with the Mississippi Medicaid Part B Crossover claim form, please follow these guidelines:

*Any attachment should be marked with the beneficiary’s name and Medicaid ID number.

* For different claims that refer to the same attachment, a copy of the attachment must accompany each claim.

* For claims with more than one third- party payor source, include all EOBs that relate to the claim.

* For third party payments less than 20% of charges, indicate on the face of the claim, LESS THAN 20%, PROOF ATTACHED.

* For Medicare denials, indicate on the claim, MEDICARE DENIAL, SEE ATTACHED.

* For other insurance denials, indicate on the claim, TPL DENIAL, SEE ATTACHED.

Billing Tip 

Some Medicare Part C Advantage Plans have a co-pay/co-insurance field or a co-pay/deductible field on their Explanation of Medicare Benefits (EOMB). The Division of Medicaid will only pay co-insurance and/or deductible. Claims submitted with these types of EOMBs will be returned to the provider and may be resubmitted with written documentation from the health plan verifying the coinsurance or deductible amount(s). Medicaid does not pay co-pay for these claim types.

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