PRV1_0119_ProviderManual-Commercial.pdf

However we will accept submitted claims for a period

This preview shows page 53 - 54 out of 91 pages.

within 90 days of service. However, we will accept submitted claims for a period of one year from the date of service. Additionally, PacificSource will accept rebillings six months from the date the original claim was processed. Initial bills, rebills, and adjustments that are received after this stated period of time will not be payable by PacificSource or by our member. PacificSource strives to make the claims process as efficient as possible. We ask that when you submit a corrected claim that it is submitted with our Corrected Claim Form and chart notes, if applicable. This form will help us to more easily assess the reason for the change, resulting in a faster turnaround time. Please do not submit corrected claims without the Corrected Claim Form as these are seen as duplicate submissions and will be denied. At this time we are unable to accept corrected claims in electronic format. You can find the Corrected Claim Form in the Providers > Forms and Materials section of our website, PacificSource.com. If a claim is not approved, and you believe it is an error, simply resubmit the claims and an explanation to PacificSource for reconsideration, providing time limitations are not exceeded. PacificSource will review the case to determine whether the claim is eligible for payment under the terms of the contract. You will be notified in writing of the determination. Note: Multiple resubmissions will calculate from the original date the claim was processed.
Image of page 53

Subscribe to view the full document.

Section 10 | Filing Claims 50 10.2.1 CMS 1500 Form Implementation In preparation for ICD-10, the CMS 1500 claim form has been updated to accommodate the new code set. Please be aware of the following time line: January 1–March 31, 2014: You can use either the current (08/05) or the revised (02/12) 1500 claim form. Health plans, clearinghouses, and billing vendors will accept and process either version of the form. Beginning April 1, 2014: The current (08/05) 1500 claim form will be discontinued; only the revised (02/12) 1500 claim form is to be used. All rebilling of claims will be on the revised (02/12) 1500 claim form from this date forward, even though earlier submissions may have been on the current (08/05) 1500 claim form. 10.3 UB04 Instructions The UB04 claim form is available in the For Providers– Forms section of our website, PacificSource.com. You may also obtain the form by contacting our Provider Network department by phone (541) 684-5580, or toll-free at (800) 624-6052, ext. 2580, or by email at [email protected] The preparation of the form in its entirety is encouraged. This will eliminate the need for PacificSource to request additional information, and will enable us to process the bill quickly. A separate billing form is required for each patient and must be legible. General and specific instructions are listed for assistance in completing the claim form correctly.
Image of page 54
You've reached the end of this preview.
  • Winter '16
  • Dr. Vincent Onyebuchi
  • PacificSource

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern