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MeridianTotal - Quick Billing Guide · PDF file Quick Billing Guide This guide explains how to submit a claim to MeridianTotal, identifies claim forms, and provides tips to ensure

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  • Quick Billing Guide This guide explains how to submit a claim to

    MeridianTotal, identifies claim forms, and provides tips to ensure you are following

    HFS guidelines and processes.

    Questions? Contact Us:

    Provider Services: 877-941-0482 mmp.MeridianTotal.com

    http://mmp.MeridianTotal.com

  • Claim Submission Process

    MeridianTotal accepts CMS 1500 (Professional Claims), UB-04 (Institutional Claims), EDI and claims submitted on our Website Portal*

    https://mmp.MeridianTotal.com/mmp/for-providers0/provider-login.html *You must request access to the secure site by registering for a user name/password and have

    requested claims access. To obtain an ID, please contact Provider Services at 877-941-0482.

    • Claims must be received by MeridianTotal no later than 180 days from the date on which services or items are provided.

    Requests for Reconsideration must be received within 90 days of the original determination or Explanation of Payment (EOP). Corrected claims must be submitted within 180 days of service or date of discharge, whichever is later.

    https://mmp.MeridianTotal.com/mmp/for-providers0/provider-login.html

  • Billing Do’s and Don’ts

    DO – •

    Submit your claim within 180 days of the

    DOS

    Submit on a proper original form CMS

    1500 in Red

    Mail to the correct PO Box number

    Submit all paper claims in a 9 x 12 or

    larger envelope

    Type all fields completely and accurately

    Use type blue or black ink only in 9 pt

    font

    Include all other insurance information;

    policy holder, carrier name, ID number,

    address

    Recheck all information before mailing

    DON’T – •

    Submit handwritten claims

    Use red ink on claim forms

    Circle on claim forms

    Add extraneous information to any field

    Use highlighter on any field

    Submit photocopies or black and white

    forms

    Submit carbon copied claim forms

    Submit claim forms via fax

    Send a copy of the claim or a claim form

    with a reconsideration or dispute

  • Corrected Claims, Claim

    Reconsiderations, Claim Disputes Adjusted or Corrected Claim

    Attn: Corrected Claim

    P.O. Box 3060 Farmington, MO 63640-3822

    Request for Reconsideration (First Level Dispute)** Attn: Reconsideration

    P.O. Box 3060 Farmington, MO 63640-3822

    Claim Dispute (Second Level Dispute)** Attn: Claim Dispute

    P.O. Box 3060 Farmington, MO 63640-3822

    *Do not send a copy of the claim or a claim image (any version of the claim) with your claim reconsideration or claim dispute

    **Utilize the Claim Reconsideration Request form and Claim Dispute form located on mmp.MeridianTotal.com under the “Forms” section here: https://mmp.MeridianTotal.com/mmp/for-providers0/provider-resources/ manuals-forms-resources.html

    mmp.MeridianTotal.com https://mmp.MeridianTotal.com/mmp/for-providers0/provider-resources/manuals-forms-resources.html https://mmp.MeridianTotal.com/mmp/for-providers0/provider-resources/manuals-forms-resources.html

  • CMS 1500 – Professional Paper Claim Form

    Important Notes:

    1: Box 24J: Top Gray Area= Taxonomy

    Bottom White Area= NPI

    2: Box 33: Billing Provider Information

    1

    2

  • CMS 1500 Billing

    Form Instructions Item Field Requirement Description/Instructions

    1 Required Indicate the type of health insurance for which the claim is being submitted for. For example, check Medicaid

    1a Required Enter the member's Medicaid ID #

    2 Required Enter in the member's full name; last name, first name, middle initial

    3 Required Enter in the member's date of birth using MMDDYYY and sex checking the box for member's gender

    5 Optional Enter in the member's address

    6 Required Checkmark "self"

    21 Required Enter in the diagnosis code(s) for the member

    22 Optional Enter in resubmission code with original claim reference number

    23 Required Enter in the authorization number (if applies)

    24 A-G Required This section is comprised of six service lines that are divided horizontally. A valid claim must have at least one completed service line

    24A Required

    Enter in the dates of service using a MMDDYYYY. A "from" date and "to" date must be entered and have occurred after t he date the claim is

    submitted

    24B Required A two-digit place of service is required

    24D Required Enter the appropriate procedure/service code

    24E Required Enter a "1" in this field. This points to the diagnosis code you place in field 21

    24F Required Enter in the total charge for the service line

    24G Required Enter in the amount of units of service billed as appropriate

    24J Required Enter in the providers Taxonomy code in the gray area on top and the NPI number in the bottom white are

    25 Required Enter in the providers Tax ID number - also check the box to determin which topy of Tax ID number is being used

    26 Optional This is a reference number for the member.

    27 Required

    Checkmark "yes"

    28 Required Enter in the total of all service line charges. The total charge amount must equal the sum of all service line charges.

    31 Required

    A signature and date are required. It can be an original signature, stamped, typewritten, or p rinted. It must be the name of a person - it cannot

    be "signature on file" or t he name of a facility. Use MMDDYYYY

    32 Required Enter the service location name and address

    33 Required Enter in the billing provider's name, address, and phone number

  • CMS 1450 (UB-04) Institutional

    Claim Form

  • Electronic Billing Inquiries

    ACTION CONTACT

    If you would like to transmit claims electronically… Contact one of the clearinghouses for MeridianTotal's payer ID.

    If you have a general EDI question…

    Contact EDI Support at 800-225-2573 Ext. 6075525 or via email at

    [email protected]

    If you have questions about specific claims transmissions

    or acceptance Claim Status reports… Contact your clearinghouse technical support area.

    If you have questions about your Claim Status (if claim

    has been accepted or rejected by the clearinghouse)…

    Contact EDI Support at 800-225-2573 Ext. 6075525 or via email at

    [email protected]

    If you have questions about claims that are reported on

    the Remittance Advice… Contact Provider Services at 877-941-0482

    If you would like to update provider, payee, UPIN, Tax ID

    number or payment address information…

    Please submit changes via e-mail to [email protected]

    For questions about changing or verifying provider

    information… Contact Provider Services at 877-941-0482 or by fax 844-409-5557

    mailto:[email protected] mailto:[email protected]

  • HFS Sterilization Forms

    –HFS 2189

    Must be completed and

    signed by both patient

    and physician

    See arrow pointing out

    section with important

    instruction information –

    this section needs to be

    indicated per HFS or

    claim will be denied.

  • Acknowledgment of Receipt of

    Hysterectomy Information

    Form-HFS 1977

    This needs to be

    completed and signed by

    the patient and Physician

  • Common Causes of Upfront Rejections •

    Unreadable Information – Information within the claim form cannot be read. The ink is faded, too light, or too bold (bleeding into other characters or beyond the box), the font is too small, or information is hand written or submitted

    on a black and white claim form.

    Member Name or identification (ID) number/DOB (date of birth) is missing or invalid.

    Provider Name, Taxpayer Identification Number (TIN), or National Practitioner Identification (NPI) number is

    missing.

    DOS – The DOS (date of service) on the claim is not prior to receipt of claim (future date of service).

    DATES – A date or dates are missing from required fields. Example: “Statement From” UB-04 & Service From” 1500 (02/12). “To Date” before “From Date”.

    TOB – Invalid TOB (Type of Bill) entered.

    Diagnosis Code is missing, invalid, or incomplete.

    Service Line Detail – No service line detail submitted.

    DOS (date of service) entered is prior to the

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