2021 VHP Provider Manual

Page 102

Back to Chapter 13 Table of Contents

Chapter 13 Includes: (Continued) 15. National Provider Identification

Alert Alert draws attention to critical information that has changed this year.

16. Assembly Bill (AB) 72 17. Provider Preventable Conditions

Contact Contact information on who to contact for assistance.

18. Third Party Liability 19. Coordination of Benefits

Book Table of Contents Click the purple VHP circle logo, located at the bottom left corner, to return to the main TOC.

20. Claims Overpayments 21. Provider Dispute Process 22. Reimbursement Policies 23. Claim Edits and Industry Standard Correct Coding 24. CPT and HCPCS Codes 25. Modifiers 26. ICD-10-CM/PCS Codes 27. Type of Bill 28. Revenue Codes 29. Diagnosis Related Group (DRG) 30. National Drug Code Number 31. Nationally Correct Coding Initiative Edits 32. Edit Updates and Changes 33. NCCI Edit Claims Denials 34. VHP’s Claim Auditing Software 35. Payment/denial codes 36. Review Schedules and Updates 37. Claims Auditing

p.97

CH 13: Claims & Billing Submission

2021 / Provider Manual


Articles inside

Ch 22: Delegated Entities

3min
pages 201-203

Ch 21: Regulatory & Compliance Requirements

14min
pages 192-200

Ch 20: Quality Management

12min
pages 183-191

Ch 19: Behavioral Health Services

19min
pages 171-182

Ch 17: Utilization Management

30min
pages 144-166

Ch 18: Case Management

4min
pages 167-170

Ch 16: Pharmacy Services

18min
pages 131-143

Ch 15: Provider Disputes & Member Grievances

8min
pages 124-130

Ch 13: Claims & Billing Submission

29min
pages 102-121

Ch 14: Encounter Data

2min
pages 122-123

Ch 10: Primary Care Providers & Other Providers

14min
pages 84-92

Ch 12: Timely Access Requirements

5min
pages 96-101

Ch 9: Credentialing & Recredentialing

26min
pages 65-83

Ch 11: Locum Tenens

4min
pages 93-95

Ch 6: Cultural, Linguistics, & Disability Access Requirements & Services

8min
pages 49-54

Ch 2: Resources for Providers

10min
pages 12-19

Ch 4: Member Benefits, Exclusion, & Limitations

12min
pages 33-44

Ch 5: Member Rights & Responsibilities

5min
pages 45-48

Ch 3: Enrollment & Elligibility

14min
pages 20-32

R Record Review

9min
pages 59-64

CH 1: Introduction

6min
pages 6-11

Ch 7: Health Education Program

4min
pages 55-58
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