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FAQ: Medicaid Billing Claims Status - PA. GOV In the meantime, providers must bill the primary insurance for denial and use Attachment Type Code 11 on the CMS-1500 claim form If submitting electronically, use the reason code from the EOB or 835 in the appropriate TPL loops
PROMISe Provider Handbooks and Billing Guides - PA. GOV Please choose the appropriate provider type or specialty below to view the PROMISe™ handbook and billing guide appropriate for you This section of the DHS website contains PROMISe™ provider handbooks and billing guides for all provider types
Billing Manual - PA Health Wellness Below are some code related reasons a claim may reject or deny: • Code billed is missing, invalid, or deleted at the time of service • Code is inappropriate for the age or sex of the member • Diagnosis code is missing the 4th or 5th digit as appropriate
Claim Submission - Example Scenarios - promise. dhs. pa. gov Select one of the links below for an example of how to submit a claim of that type Note: these scenarios offer providers general guidelines in the completion of electronic claims paper equivalent and are not inclusive of all information needed to complete a claim for all provider types
Claims Filing Instructions Medical Providers April 2025 be easily adjusted Adjusted Claims cannot involve changing any fields on a Claim (for example an incorrect code) and can often be corrected over the phone or through NaviNet Adjusted Claims usually involve a dispute about amount level of payment or could be a denial for no authorization when the Network Provider has an authorization number
PROMISe Companion Guides | Department of Human Services | Commonwealth . . . Companion guides are developed to communicate the Pennsylvania Medicaid-specific information required to successfully submit healthcare transactions They usually contain the department interpretation and application of the data elements and how to convey the data for department transactions
Reason Remark Code Lookup - WPS Government Health Administrators Use the Code Lookup to find the narrative for ANSI Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) You can also search for Part A Reason Codes Claim Adjustment Reason Codes explain why a claim was paid differently than it was billed
Claim Adjustment Reason Codes - X12 These codes describe why a claim or service line was paid differently than it was billed Did you receive a code from a health plan, such as: PR32 or CO286? If so read About Claim Adjustment Group Codes below The procedure code is inconsistent with the modifier used
Are You Puzzled by Your Remittance Advice Statement? - PA. GOV happened to your claim and if there are actions that need to be taken Please note that there are several codes that are for informational purposes only These explanation codes do not cause your claim to deny For example, you may see the code 9000 (Billed Amount Exceed Allowed Amount) setting with the status of “P” for paid on your claim