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Provider Manual Title: Nursing Facilities Revision Date: 7/27/2023 Chapter V: Billing Instructions ___CHAPTER V BILLING INSTRUCTIONSProvider Manual Title: Nursing Facilities Revision Date: 7/27/2023 Chapter
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01
Collect all the necessary documentation and data related to the pre-payment review process.
02
Review the claims that are subject to pre-payment review.
03
Carefully analyze the review results and determine any errors or discrepancies.
04
Correct any identified errors or discrepancies by providing the necessary documentation or making adjustments.
05
Submit the corrected claims for further review.
06
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Keep detailed records of the entire process for future reference and audit purposes.

Who needs pre-payment review results for?

01
Healthcare providers and organizations who are required to undergo pre-payment review by insurance companies or government healthcare programs.
02
Medical billing and coding professionals who need to ensure accurate and compliant claims submission.
03
Administrative staff in healthcare facilities who are responsible for handling claims and reimbursement processes.
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Pre-payment review results are used to assess the accuracy and validity of claims before they are paid, ensuring that only appropriate payments are made.
Providers and organizations that submit claims for reimbursement under certain healthcare programs are required to file pre-payment review results.
To fill out pre-payment review results, providers must complete the designated forms provided by the overseeing authority, ensuring all necessary information and documentation is included.
The purpose of pre-payment review results is to prevent fraud, waste, and abuse in healthcare spending by verifying claims before payment is processed.
Pre-payment review results must report details such as claim numbers, patient information, service dates, and any discrepancies or issues identified during the review.
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