Thursday, November 25, 2010

ambulance billing - claim tips

Billing Information

• Submit the most updated industry-standard codes.

• Submit the appropriate modifier as indicated in the Origin and Destination Modifier Table on page 4.

• Submit non-emergency ambulance and/or scheduled ground transportation claims with a completed medical necessity form. Non-emergency ambulance and/or scheduled ground transportation electronic or paper claims submitted without a medical necessity form will deny as provider responsibility.

• Electronic submitters must fax a copy of the completed medical necessity form to the Precertification Department at (617) 972-9409 for non-emergency ambulance and/or scheduled ground transportation the same day the claim is submitted.

• Non-emergency ambulance and/or scheduled ground transportation claims submitted on paper must have the completed medical necessity form accompanying the claim.

• Tufts Health Plan will accept medical necessity forms that are used by the ambulance provider for non-emergency and/or scheduled ground transportation claims.

In the event that an ambulance provider must submit a claim for a service where the member has acknowledged liability, submit a medical necessity form indicating the service is not a covered service with a valid waiver indicating that the member has been notified that the service is not covered and the member has assumed liability. This will ensure accurate claim adjudication.

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