Hospital
Please review the Medicare Learning Network (MLN) Matters article on the Centers for Medicare & Medicaid Services (CMS) website to see changes, additions, and deletions of Ambulatory Payment Classification (APC) codes, Health Care Common Procedure System Codes (HCPCS), and diagnosis codes to ensure correct billing and processing of claims that are routed through the Outpatient Code Editor (OCE). Please review the "Background" and "Additional Information" sections for additional details. This article is available on line at http://www.cms.hhs.
gov/MLNMattersArticles/downloads/MM6186.pdf.
(posted 10/08/2008)
Inpatient Authorizations: Inpatient authorization numbers are sent to providers after notification of the inpatient stay. These authorization numbers should only be used on claims for the inpatient stay. The authorization number should only be used for the dates of the stay, which is found on the authorization approval form. (06/16/08)
Inpatient Admissions: Hospitals must notify PrimeWest's Care Management Department upon admission of a PrimeWest member, even if the patient has another insurance that is primary. Hospitals can reach PrimeWest Care Management by calling 1-866-431-0803 or via fax at 1-866-431-0804. The hospital verifies member eligibility at that time. Notification by the hospital is necessary to ensure timely and accurate claim reimbursement.
Non-Emergency Services Provided in the Emergency Department: For billing and payment information see the DHS update OUT-06-01 here
Physicians: Use modifier 51 for multiple surgeries performed by the same operative sessions. See information on modifier 51 here