Speaking of NPI. . . is anybody else getting denials from Blue Cross because the NPI isn't on the claim? 1500 claim, specifically.
Julia F. Carter, CPAR Systems Analyst Revenue Management Colquitt Regional Medical Center 3131 South Main Street PO Box 40 Moultrie, GA 31776-0040 (229) 891-9133 Voice http://www.colquittregional.com Note: The information contained in this electronic message and any attachments may be privileged and confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any reading, dissemination, distribution, copying, or other use of this communication or any of its attachments is strictly prohibited. If you have received this communication in error, please notify the sender immediately by replying to this message and deleting this message, any attachments, and all copies. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Richardson, Tim Sent: Monday, October 23, 2006 4:06 PM To: Gary Ring; Kim Corrette; [email protected] Subject: RE: [MEDITECH-L] Medicare e-claim submissionsfor Providers notin Provider dictionary Not to mention the NPI next spring- oh boy :( Tim Richardson IS Senior Consultant CentraState Healthcare System [EMAIL PROTECTED] Extension 732.294.2719 -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Gary Ring Sent: Friday, October 20, 2006 12:24 PM To: Kim Corrette; [email protected] Subject: Re: [MEDITECH-L] Medicare e-claim submissionsfor Providers not in Provider dictionary Kim: This is a problem that plagues many, if not most, hospitals. Technically, the physician shouldn't be treating patients if they are not credentialed, or treating Medicare patients if they don't have a UPIN/PIN. Some hospitals I've worked with have just the opposite problem: they enter the physician into the Dictionary if they've been credentialed by don't have a UPIN/PIN yet. In these cases, we REJECT/Hold the claim because it is missing a UPIN/PIN; when the physician gets the PIN, the claim automatically drops. In your case, it sounds like your physician already has a UPIN/PIN. So in this case, you could probably enter the Physician into the Doctor Dictionary with his Medicare UPIN so that the electronic claim will generate correctly. Though, I'm not sure what the legal implications are if the physician is not credentialed in your organization or licensed in your state. In any case, these scenarios would seem to be an issue for Sr. Management to tackle; e.g., should they be allowing physicians to treat or refer Medicare patients to your organization if they are (1) not credentialed, or (2) don't have a UPIN necessary to be reimbursed for providing services to Medicare patients. Gary J. Ring Strategic Resource Group, Inc. 978-807-1573 ---- Original message ---- >Date: Wed, 18 Oct 2006 12:12:03 -0800 >From: "Kim Corrette" <[EMAIL PROTECTED]> >Subject: [MEDITECH-L] Medicare e-claim submissions for Providers not in Provider dictionary >To: <[email protected]> > > Historically, our hospital has only entered > providers into the MIS Provider Dictionary after > they complete their credentialing process with us. > We are Magic 5.5 SR3 and use LSS. When a > non-credentialed provider sent us a Medicare > patient, we submitted the claim on paper and wrote > in the UPIN. Now that Medicare requires electronic > submission for all claims, how have other facilities > handled the submission of a claim for a provider who > is not in the Provider dictionary? The electronic > claim process pulls the UPIN from the Provider > Dictionary and does not allow other entries. TIA - > > > > Kim Corrette, RN > > Clinical Systems Analyst > > Bartlett Regional Hospital > > Juneau, AK > > (907)796-8838 > > > > > > > > >________________> > >====================================== >All messages should be posted in plain text. >HTML will be converted to attachments. > >The meditech-l web site is MTUsers.com >______________________________________ >meditech-l mailing list >[email protected] >http://mtusers.com/mailman/listinfo/meditech-l ====================================== All messages should be posted in plain text. HTML will be converted to attachments. 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