Billing procedures

Below is a list of topics included in the “Billing procedures” section of the Provider Manual. To view this section, click the link below.

• Open the “Billing procedures” section of the Provider Manual

Topics

• Introduction
• Fallon Community Health Plan's commitment to quality
  • Claims department quality audits
  • Claim Code Auditing
• Claims guidelines
  • Submitting a claim
  • Referrals and preauthorizations
  • Filing limits
  • Late charges
  • Covering physicians
  • Balance billing
  • Claims that should not be submitted directly to FCHP
• Claims submissions
  • Submitting claims directly to FCHP
  • Submitting claims electronically through an FCHP clearinghouse
  • Using the CMS 1500 claim form
  • Billing and payment guidelines for professional claims **
  • Using the UB-04 claim form
  • Billing and payment guidelines for facility claims
• Coordination of benefits
• Claim status checks
• Understanding your Remittance Advice Summary
  • Remittance Advice Summary—Field definition
  • Sample Remittance Advice Form
  • Explanation of disposition codes
  • Sample Pended Claims Report
• Overpayments on FCHP's part
• Negative balances
• Adjustments and appeals
• Reference section
  • Reference A - Coding
  • Reference B - Modifiers
  • Reference C - Place of service codes 
  • Reference D - Bilateral procedures

** This section contains information regarding the EPDST Service: Medical Protocol and Periodicity Schedule and EPSDT/PPHSD Screening Service Codes.