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Form 542.3 Application for claim review Workers Compensation and Rehabilitation Act 2003 (the Act). This is an approved form under section 542 of the Act. Please read the information attached to this

Instructions and Help about claim review form 542

Hello I'm Charles Kiel senior provider education consultant at palmetto GBA today we are going to give you the nuts and bolts on submitting the PRE claim review requests or home health you have already seen the video on the background of the PRE claim review why we have it and the basics of the claims processing side today we're going to give you the inside track on making sure you have the right documentation to tell your story, so we are going to walk through exactly how to put this together now there are various ways to do it you can do it electronically fax mail that's not going to matter as long as you have all the pieces in there as long as you get it to us, you give us the right information you will have an affirmed claim we have to have the right beneficiary information that kind of sounds like a given but make sure we have the right beneficiary information a beneficiary name and the pic number there are a lot of John Smith's out there in Medicare so just put in John Smith's name on there without his date of birth or the Medicare number we're not going to know which patient that is we have to have the certified physicians' information, so that will be his name his NPI now his P tan is optional but the NPI is mandatory, and we have to have the practice address we also need you home health information, so we do need your agency's name we have to have your NPI, and we do need your Pete and your provider number the reason is only certain states are allowed to bill these PRE claim review requests, so you're Pete and that six-digit number that goes on your those first two digits tell what state you're in so if you're from the state that's not part of the PRE claim review process it will not go through so your pee-can is very important as well if your agency address it's very important to have a contact name and a telephone number in the event that there is a processing issue something does not go as planned we need to know who to contact to resolve something, so please put a specific person's phone number the operator is not very helpful because we don't know who they ask for if that's the only number you give us so a specific name and a specific phone number that goes to a specific person is what we need other information that must be part of the process or the claim will not go through have to reference the episode the dates so the beginning and end or the through and from dates as most people refer that have to be in there the submission date meaning the date that you submit the request needs to be there and we also you know if this is an initial or a resubmission means you submitted at one time it was out of some pieces missing or some element that did not pass first review, and you're been submitting it and once again you have to have the state now again just a quick review of the Medicare requirements because what you're doing with this PRE claim review is you are showing the reviewers at Palmetto GBA that this patient meets the home...

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What is claim review form 542?

Claim review form 542 is a document used to request a review of a claim that has been denied or disputed.

Who is required to file claim review form 542?

Anyone who has had a claim denied or disputed may be required to file claim review form 542.

How to fill out claim review form 542?

To fill out claim review form 542, you must provide your contact information, details of the claim, reason for the review request, and any supporting documentation.

What is the purpose of claim review form 542?

The purpose of claim review form 542 is to initiate a review process for claims that have been denied or disputed by the payer.

What information must be reported on claim review form 542?

The information required on claim review form 542 includes the claimant's name, contact details, claim details, reason for review request, and any supporting documentation.