2013 Practitioner and Provider Manual - Presbyterian Healthcare ...
2013 Practitioner and Provider Manual - Presbyterian Healthcare ...
2013 Practitioner and Provider Manual - Presbyterian Healthcare ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
e-Business18. Claims <strong>and</strong> Payment18. Claims <strong>and</strong> Payment<strong>Presbyterian</strong>’s Claims Department ensures thatclaims submitted by our providers are processedaccurately <strong>and</strong> in a timely manner. The primaryreimbursement tools used in this process areThe application of correct coding guidelines inaccordance with the st<strong>and</strong>ards set by the Centersfor Medicare <strong>and</strong> Medicaid Services (CMS) <strong>and</strong> theAmerican Medical Association (AMA)Individual provider contractual arrangementsThe application of specific member benefitsThe requirements in this chapter of the <strong>Provider</strong><strong>Manual</strong> can help you ensure that your claims aresubmitted correctly.Requirements for the Health Insurance Portability<strong>and</strong> Accountability Act (HIPAA) of 1996, as weunderst<strong>and</strong> them today, are included. Periodicupdates are sent to your office as necessarythroughout the year.You are required to submit claims for all servicesrendered, whether they are capitated or fee-forservice.For assistance with claim submissions,please contact your provider network managementrelationship executive(http://docs.phs.org/idc/groups/public/%40phs/%40php/documents/phscontent/pel_00140718.pdf),who can arrange for helpful technical assistance<strong>and</strong> training sessions.Electronic Claims TransmissionElectronic claims are claims that are transmittedelectronically to <strong>Presbyterian</strong> using a clearinghouseor a web application such as <strong>Presbyterian</strong>’selectronic claims transmission (ECT) system. UsingECT can capitalize on the time <strong>and</strong> savingsrealized from a paperless system. To submitelectronic claims directly to <strong>Presbyterian</strong>, providerscan use the Fast Claim direct entry portal at(https://www.claim.md/phs.plx).Fast Claim is designed to accommodate lowervolumeclaim submitting practices that would like tosubmit claims electronically directly to PHP at nocost. To learn more about ECT or Fast Claim,please contact the provider network managemente-business analyst at 505-923-8726. A list ofclearinghouses is also available at the end of the e-Business chapter. Since October 16, 2003,electronically transmitted claims must meet theHIPAA transaction st<strong>and</strong>ards with regard to format<strong>and</strong> content. Corrected claims should not besubmitted electronically.Benefits of Filing Electronically<strong>Presbyterian</strong> processes electronically submittedclaims faster than hard copy claims. Electronicsubmission saves you postage <strong>and</strong> paper, <strong>and</strong>provides you with the following:18-12014 <strong>Practitioner</strong> <strong>and</strong> <strong>Provider</strong> <strong>Manual</strong> - Ver. 3
Change language