Get the free PA PROMISe 837 ProfessionalCMS-1500 Claim Form Provider - dpw state pa

PA Promise 837 Professional/CMS1500 Claim Form Provider Handbook Appendix A Billing Guides Table of Contents APPENDIX A BILLING GUIDES .........................................................................................................................1

How to fill out pa promise 837 professionalcms-1500

How to fill out pa promise 837 professionalcms-1500:

1. Start by entering the patient's personal information. This includes their full name, address, date of birth, and gender.
2. Next, provide the patient's insurance information. This includes their insurance company name, policy number, group number, and the name and address of the primary insured if different from the patient.
3. Indicate whether the patient has any other health insurance coverage. If yes, provide the relevant details such as the name of the other insurance company and the policy number.
4. Moving on, provide the patient's diagnosis or nature of illness. This is typically indicated with the corresponding ICD-10 codes.
5. Specify the dates of service for the medical treatment being claimed. This includes the start and end dates of the treatment period.
6. Provide the corresponding CPT or HCPCS codes for the services rendered. These codes describe the specific medical procedures or services done.
7. Enter the charges for each service provided. This includes the total amount charged by the healthcare provider for each procedure.
8. Indicate any payments received from the patient or any applicable coverage, such as deductible or copay amounts.
9. Finally, sign and date the claim form to certify that the information provided is accurate to the best of your knowledge.

Who needs pa promise 837 professionalcms-1500?

1. Healthcare providers: Medical professionals, clinics, and hospitals who offer services to patients under the Pennsylvania Medical Assistance (MA) program.
2. Patients under the Pennsylvania MA program: Individuals who are eligible for medical assistance through the state program and receive healthcare services from providers enrolled in the PA PROMISe system.
3. Insurance companies: Companies that administer the Pennsylvania MA program and process claims submitted by healthcare providers using the pa promise 837 professionalcms-1500 form.

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What is pa promise 837 professionalcms-1500?

Pa promise 837 professionalcms-1500 is a standard form used for submitting healthcare claims electronically.

Who is required to file pa promise 837 professionalcms-1500?

Healthcare providers, such as doctors, hospitals, and other medical professionals, are required to file pa promise 837 professionalcms-1500.

How to fill out pa promise 837 professionalcms-1500?

Pa promise 837 professionalcms-1500 should be filled out with the patient's information, diagnosis, treatment provided, and other relevant details related to the healthcare service.

What is the purpose of pa promise 837 professionalcms-1500?

The purpose of pa promise 837 professionalcms-1500 is to streamline the billing and reimbursement process for medical services.

What information must be reported on pa promise 837 professionalcms-1500?

Information such as the patient's name, date of birth, insurance information, diagnosis codes, treatment codes, and charges must be reported on pa promise 837 professionalcms-1500.

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