To obtain a national provider identifier (NPI) you may: All providers are required to submit claims and encounters using current HIPAA compliant codes, which include the standard CMS codes for ICD10, CPT, HCPCS, NDC and CDT, as appropriate. Standard Code Sets as required by HIPAA are the codes used to identify specific diagnosis and clinical procedures on claims and encounter forms. To ensure timely claim processing, PHC California requires that adequate and appropriate documentation be submitted with each claim filed.ĭocumentation required with a CMS1500 or UB04 claim form:ĭoctor’s orders, nursing or therapy notesįull medical record with discharge summary We accept the revised CMS-1500 and UB-04 forms printed in Flint OCR Red, J6983, (or exact match) ink. Health Care Procedure Coding System (HCPC)ĬMS-1500 paper claim submissions must be submitted on form OMB-0938-0999(08-05) as noted on the document’s footer.International Classification of Diseases (ICD10-CM) for diagnostic coding.Current Procedural Terminology (CPT) for physician procedural terminology.Only current standard procedural terminology is acceptable for reimbursement per the following coding manuals: PHC California will process only legible claims received on the proper claim form that contains the essential data elements described above. Name and state license number of rendering providerĬlaims that do not meet the criteria described above will be returned to the provider indicating the necessary information that is missing.Place of service or UB04 bill type code.
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