The Claims Billing Manual provides guidance for billing both professional (CMS-1500) and institutional (UB04) paper and electronic claims. It is not intended to be a comprehensive document of all policies and procedures.
Understand the laws pertaining to the prevention and detection of fraud, waste, and abuse, in accordance with the requirements of the federal Deficit Reduction Act of 2005.
Learn where to send refunds for errors in claims payments.
Learn how to submit a payment dispute.
Electronic Claims Submission and Electronic Funds Transfer (EFT) / Electronic Remittance Advise (ERA)
Prior authorization is required for elective and direct placement into observation (i.e. from home, physician office, etc.)
Information current as of: