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Interactive 1450 (UB-04) Form

Wed, 2010-09-01 09:55

To assist electronic billing customers with error messages received on the electronic reports, an interactive 1450 (UB-04) form has been developed as a crosswalk. This crosswalk is an interactive feature that displays the appropriate loops, segments, and qualifier detail when clicking on each block of the 1450 (UB-04) sample claim form. A crosswalk chart is also available to provide a complete list of the crosswalk information.

Common Cert Errors 2010

Fri, 2010-08-13 11:49

During the first quarter of 2010, 158 CERT errors were assessed for all Part B contracts within Highmark Medicare Services (HMS). Of those 158 errors, 77 errors were due to insufficient documentation (error code 21), 40 were due to incorrect coding (error code 31), 38 were due to medical necessity (error code 25), and 3 was due to improper documentation submitted to the CERT contractor (error code 16).

 The Part B CERT errors that were received for Highmark Medicare Services during this quarter remain relatively unchanged from the last quarter.

OVA1™

Thu, 2010-04-01 15:42

OVA1™ is an FDA-cleared qualitative serum test that combines the biomarker values of five immunoassays, using a proprietary algorithm, to further assess the likelihood that an ovarian mass is malignant, in women whose pre-surgical assessment did not indicate malignancy.

Highmark Medicare Services will cover OVA1™ in keeping with the FDA-cleared indication until such time that a Local Coverage Determination is developed and implemented. OVA1™ is currently indicated for women who meet the following criteria:

  • Over the age of 18, and

Analysis of Part B CERT Data - October through December 2009

Thu, 2010-03-04 10:46

During the fourth quarter, 148 CERT errors were assessed for all Part B contracts within J12. Of those 148 errors, 66 errors were due to insufficient documentation (error code 21), 47 were due to medical necessity (error code 25), 33 were due to incorrect coding (error code 31) and 2 were due to service billed were not rendered (error code 41).

How to determine if a Physician or Non-Physician who is Eligible to Order or Refer Services has a Current PECOS Enrollment Record

Thu, 2010-03-04 10:46

Although enrolled in Medicare, many physicians and non-physician practitioners who are eligible to order items or services or refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in the Provider Enrollment, Chain and Ownership System (PECOS). A current enrollment record is one that is in the PECOS and also contains the National Provider Identifier (NPI). The lack of a current enrollment record in the PECOS is a result of not having submitted any enrollment information updates since November 2003.

Physician Signature Requirements for Diagnostic Testing

Wed, 2010-01-06 15:26

YOU Impact the National Medicare (CERT) Error Rate

Wed, 2010-01-06 15:26

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