Locum Tenens

If a Locum Tenens is filling in for a provider, please enter “Locum Tenens” in Box 31 of the CMS 1500 form. This will expedite payment and prevent denials due to the Tax ID not matching  the provider who performed the service.

National Provider Identification Numbers

CMS 1500

1. Field 17a: Referring Provider Taxonomy – input ZZ in the first box and 10-character taxonomy code without spaces in the second box.
2. Field 17b: Referring Provider NPI # – input 10-character NPI Number.
3. Field 24I: ID Qualifier- ‘blak’ and preprinted ‘NPI’ spaces. Blank space should be populated with ZZ for taxonomy code listed in 24J.
4. Field 24J: Rendering Provider ID # – if ‘blank’ 24I is populated with ZZ, enter 10-digit taxonomy code in 24J. Enter the NPI Number in the correspondeing space after preprinted ‘NPI’ in 24I.
5. Field 32a: Service Facility Location NPI # – enter 10-character NPI Number.
6. Field 32b: Service Facility Location Taxonomy – input ZZ and
   10-character taxonomy code without spaces.
7. Field 33a: Billing Provider NPI# – input 10-character NPI Number. If not present the bill will be denied for this omission.
8. Field 33b: Billing Provider Taxonomy – input ZZ and
   10-character taxonomy code without spaces.

UB 04

1. Field 56: Billing Provider NPI – input 10-character NPI Number. If not present the bill will be denied for this omission.
2. Field 57: Billing Provider Taxonomy – input ZZ and
   10-character taxonomy code without spaces.
3. Field 76: Attending Provider NPI – input 10-character NPI Number.
4. Field 77: Operating Provider NPI – input 10-character NPI Number.
5. Fields 78/79: Other Provide’s NPI – input 10-character NPI Number.
6. Field 81a: Billing Provider Taxonomy – input B3 in the first box and 10-character taxonomy code without spaces in the second box. If not present the bill will be denied for this omission.

ADA Dental Claim Form

1. Field 49: Billing Provider NPI – input 10-character NPI Number. If not present the bill will be denied for this omission.
2. Field 54: Treating Dentist NPI – input 10-character NPI Number.
3. Field 56A: – Treating Provider Specialty Code – input
   10-character taxonomy code without spaces.

Implant invoices

Implant invoices need to be sent only if the outlier threshold is met:

• $10,000.00 in cost for Inpatient Hospital.
• $500.00 in cost for Ambulatory Service Center (ASC) or
• Outpatient Hospital.

Note: Cost includes freight and handling charges for the implant. Freight and handling may be adjusted if all items on the invoice are not part of the implants utilized in the surgery. Identifying those items by way of check mark (not by highlighter) assists the payment auditors with those items for which you are requesting additional outlier reimbursement. See the DLI website for more information regarding implants.

Radiology

If billing for radiology services, please make sure that the type of X-ray provided is documented (i.e., type/# of views) as well as the location and the result/interpretation. The actual radiology report is preferred and recommended to better substantiate the service being billed.

If your clinic utilizes a contracted service provider for reading the films and the provider is not associated with the Tax ID of the clinic, the physician accepting the responsibility for the reading needs to countersign the report.

Pre-authorization

If you are unsure whether a service is related to a workers’ compensation injury, obtaining pre-authorization from the claim examiner is recommended. Physical and occupational therapy must be prescribed by the treating physician. The length of time and therapy duration must be included in the pre-authorization, which must be signed by the claim examiner and provider. See the DLI website for more information regarding pre-authorization information.

Re-evaluation Requests

If you are requesting a re-evaluation or reconsideration for payment or additional payment of a denied or partially denied bill, please send a copy of the CorVel Explanation of Review (EOR) with the documentation needed to:

Montana State Fund

P.O. Box 4759

Helena, MT 59604-4759

If you are sending in a corrected billing (i.e., corrected code, corrected information in boxes 31-33,  # units etc.), please write “Corrected Claim” on the billing form, attach a copy of the CorVel EOR and mail to MSF at the above address. If you are unsure of what is needed contact CorVel or a member of our medical team to assist you.

These steps will help prevent duplicate denials and will expedite the reconsideration/payment process as it assists the CorVel staff to better identify the processing action needed for request. If you have further questions, please call a member of the medical team listed at the end of this bulletin.

Payment Status

Please allow 30 days before calling regarding payment status of a bill or rebilling. Most bills are processed within 30 days; if there is a problem with a bill, it will be returned to the provider within the

30-day time frame.