Steps to prevent reject reason code 36428
Steps to prevent rejection when submitting a claim for mammography screening services.
What are the definitions of "payment floor" and "clean" claim?
The “payment floor” is a waiting period during which time the contractor may not pay, issue, mail, or otherwise finalize the initial determination on a clean claim. There are different waiting periods for electronic claims and paper claims. The waiting periods are 13 days for electronic claims and 28 days for paper claims. However, the payment may not be issued until day 14 (electronic) or 29 (paper).
What is targeted probe and educate (TPE)?
TPE reduces provider burden, claim denials, and appeals through one-on-one education.
I cannot find my specialty listed on the application, what should I do?
If your provider type, supplier type, physician specialty, or non-physician specialty type is not listed in the application, please select other, undefined physician specialty, or undefined non-physician practitioner specialty. Then list your type or specialty in the provided field.
I am an ordering and certifying provider already enrolled in one state. What should I do to update my information if I move to another state?
For providers that enroll solely to order or refer services using the CMS-855O, it is a national enrollment. When you relocate to another state, you are not required to dis-enroll from the current state and re-enroll in the new state. The contractor that maintains your CMS-855O enrollment in PECOS is responsible for processing change of information applications including relocating to a state outside of their jurisdiction and updating the current enrollment with any new licenses obtained in the new state.
Reference:
Are providers in Puerto Rico and the USVI required to submit a letter of good standing with their applications? How far in advance can the letter be dated prior to submission of the application?
Yes, for initial, revalidation and reactivation applications, a Puerto Rico and/or U.S. Virgin Islands provider is required to submit a letter of good standing with his or her application if there is no online verification source to verify a medical license. The letter of good standing is not required with a change of information application unless it involves a license update/change.
Voluntary terminations
Read this article for instructions on how to terminate your Medicare enrollment.
How do I get a copy of my Medicare certification letter that shows the certification number and effective date?
You can call the JN provider enrollment help desk at 1-888-845-8614 to request a copy of the letter, as long as you're currently listed on the enrollment record. You can also submit a request for a copy of your enrollment certification by sending a request for the information on company letterhead to First Coast’s provider enrollment department. The request needs to be signed by either the authorized official (AO), delegated official (DO) or the practitioner as it is listed on your entity’s enrollment record.