North Central Counties Introduction to Community Care's Claims ...

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Critical Claim Elements (cont.) Critical Details on a UB-92 •Box 42 •Box 43 •Box 44 •Box 45 •Box 46 •Box 48 3-Digit Revenue Code (Refer to the Community Care Fee Schedule) Revenue Code description CPT or HCPCS Procedure Code Service Date Service Units List Non-Covered charges (If Block 8 is completed) 14
Critical Claim Elements (cont.) Critical Details on a UB-92 • Box 50 Enter Payer Identification Name • Box 52 Release of Information Certification (Patient Signature on File to authorize payment to Facility / Provider) • Box 54 Prior Payment - List amount paid by other insurance • Box 55 Enter Estimated Amount due • Box 58A Enter Insured / Member’s Name 15
Page 1 and 2: North Central Counties Introduction
Page 3 and 4: General Claim Information Claims Of
Page 5 and 6: General Claim Information Our Inten
Page 7 and 8: North Central Timely Filing Standar
Page 9 and 10: Electronic Claims Submission Provid
Page 11 and 12: Critical Claim Elements Critical De
Page 13: Critical Claim Elements (cont.) Cri
Page 17 and 18: Critical Claim Elements (cont.) Cri
Page 19 and 20: Critical Claim Elements (cont.) Cri
Page 21 and 22: Critical Claim Elements (cont’) C
Page 27 and 28: Critical for Correct Payment • Me
Page 29 and 30: Initial Claims Submission - Paper
Page 31 and 32: Initial Claims Submission Provider
Page 33 and 34: Corrected Claims • Corrected UB-9
Page 35 and 36: Provider Facts What Diagnosis / Ser
Page 37 and 38: Reminders • The North Central Pre

North Central Counties Introduction to Community Care's Claims ...

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