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 providers
• 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.