MedStar Family Choice DC follows the District of Columbia's regulations in order to determine whether a claim is clean.
Standard Required Attachments
The following describes circumstances under which the identified attachment is required for submission with the claim.
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An explanation of benefits statement from a primary payer to MedStar Family Choice DC's Claims Processing Center, if MedStar Family Choice DC is secondary.
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A Medicare remittance notice, if Medicare is primary and MedStar Family Choice DC is secondary.
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A description of the procedure or service, which may include the medical record, if a procedure or service has no corresponding Current Procedural Terminology (CPT) or HCPCS code.
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Information related to an audit, if a pattern of fraud, improper billing, or coding is demonstrated.
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Provide an invoice for medication or other items per contract or when requested.
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Admitting and physician notes for emergency services that may not meet the standards for an emergency service.
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A itemization of charges may be required for inpatient hospital claims to correctly pay a bed day when other similar bed days are denied in that same inpatient admission.
Please share this information with your staff and/or billing agent as appropriate.
Information current as of: