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Most of you are familiar with the Palmetto GBA forms submitted with appeals. We are pleased to let you know that the forms for Redetermination Requests (first level of appeal) and Qualified Independent Contractor (Reconsideration) Requests (second level of appeal, formerly "hearings") are now interactive. You can launch the forms directly from our Web site, complete them electronically, then print a paper copy to submit with your appeal requests. To access the interactive forms, take the appeals shortcuts, select the form you need, then click on "view attachment": Ohio: http://www.PalmettoGBA.com/boh/appeals We hope that the interactive forms will save you time. We do want to let you know that at this time, we aren't able to accept the forms via e-mail. CMS and Palmetto GBA are extremely sensitive to the private nature of information contained in these requests, so please continue to submit the printed forms and associated documentation to us just as you always have. (Remember to sign the requests.)
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A couple weeks ago, we announced the new Modifier Lookup Web page. If you like the Modifier Lookup Web page, we hope that you will like the new Claim Resouce Lookup Web page just as much! Here is some background: What is it? - A new way of displaying resources for the most common questions and claim problems! The information is categorized by topic. It integrates all of the resources we have available for the top problem and question categories and packages them in a way that is easy to use (and they're in alphabetical
order). Searching for resources will be much easier with this new format. For example, if you're receiving "medical necessity" denials for trigger point injections, searching from the Ohio or West Virginia home page for "trigger point" will return this as one of the top results. We'll continue to add to this resource list as we find new issues or problems. Where can you find it?- From the Ohio or West Virginia home page, select Claim Resource Lookup from the "Topics" or "Resources" section: Ohio:
http://www.PalmettoGBA.com/boh
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Do you have your NPI? When applying for your NPI, CMS urges you to include your legacy identifiers, not only for Medicare but for all payors. If reporting a Medicaid number, include the associated State name. This information is critical for payors in the development of crosswalks to aid in the transition to the NPI. If you are a health care provider who bills for services, you probably need an NPI. If you bill Medicare for services, you definitely need an NPI! Getting an NPI is easy. Getting an NPI is free. The first step is to get your NPI. Once you obtain your NPI, it is estimated that it will take 120 days to do the remaining work to use it. This includes working on your internal billing systems, coordinating with billing services, vendors, and clearinghouses, testing with payers. As outlined in the Federal Regulation, (The Health Insurance Portability and Accountability Act of 1996 (HIPAA)) you must also share your NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes. If you delay applying for your NPI, you risk your cash flow and that of your health care partners as well. Getting an NPI is free - Not Having One Can Be Costly. Many NPI questions that providers and their staff may have can be answered by the resources provided on the CMS NPI page. The "NPI Question Resource Sheet" points to specific resources that can help answer common questions.
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