TRAINING
MEDICARE COMPLIANCE PRESENTS
iCare: Fraud, Waste & Abuse Prevention Awareness Training
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PROVIDER FORMS
STANDARDIZED CREDENTIALING FORM (FILLABLE PDF FORM)
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FEDERAL W-9 (FILLABLE PDF FORM)
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OFFICE INFORMATION UPDATE
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EXPLAINATION OF PAYMENT (EOP) REMARK CODES
ACC - Accident information details, carrier requested from patient - call patient
ADD - Additional payment made
ADJ - Payment adjustment made to a previously Paid claim (s)
BLD - This procedure is considered a part of the primary procedure & the charge has been added or bundled to the primary procedure (patient not responsible to pay)
CPP - Insurance Carrier / TPA PAID the patient DIRECT - bill patient
CMT - Chiropractic manipulative therapy
CB - Coordination of Benefits
COB - EOB from primary carrier required
DED - Deductible applied - bill patient
DUP - Duplicate claim - already considered
FIL - Date/ Claim past the filing limit - bill patient
FUN - Insurance premiums not paid - bill patient
INF - Information requested from patient - not received - call patient or carrier or bill patient
INT - Interest Paid by carrier
MAX - Exceeds per day or benefit limit - bill patient
MC - Maintenance therapy is not a covered expense under this plan - bill patient
MEM - Patient not eligible on date of service
MF - Modifier code is not a valid modifier for this procedure code - rebill procedure if necessary
NET - Not a ChiroHealth-Ohio contract - send to address on ID card
NMN - Carrier indicates services Not Medically Necessary based on information - bill patient or submit medical documentation directly to carrier
NSF - Check returned not sufficient funds - bill patient
OCL - Primary carrier amount paid
PAY - Corrected payment
PDD - CHO Network discount taken, physician paid direct by carrier
PEN - Claim (s) pending with carrier
PREX - Pre-existing condition - patient to provide details to carrier
REC - Medical records requested from provider or additional information required
REF - Refiled claim for additional consideration Paid wrong by carrier
STU - Full-time student status required from patient
SEC - Secondary carrier PAID amount
TERM - Insurer's or Employer contract coverage TERMED
TKB - TAKE BACK funds requested by carrier (see remarks for explanation)
WPP - Wrong provider paid
WC - Worker's comp inquiry sent to patient
X00 - X0000 code, Lump sum CHIRO payment for Single or Multi DOS or CPT codes
Z00 - Code, PAID DOS as received from carrier / or claims not submitted properly to CHO.
Not Allowed - patient not liable - Do Not bill the patient for this column
Pt. Resp - Patient Responsibility - Co-Pay/ Co-Ins/ MAX/ Non-covered services - patient to pay provider this column