- Health First Colorado School Health Services
- School Health Support Program Manual
- Prior Authorization Requirements
- Procedure Codes/Billing Provisions
- Acronyms
- Paper Claim Reference Table
- Health First Colorado School Health Services Revision Log
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Health First Coal School Health Services
The Colorado School Human Services Program allows school districts and Boards of Cooperative Education Services (BOCES) to access federal Physical First Colorado capital for delivering Health First Colorado allowable school general solutions to Health First Colorado enrolled children. Reimbursement received by a district through the School General Services Program shall be used by one district up provide additional and augmented health service. School Nurses Our | Oklahoma State Department of Education
School Health Services Program Manual
In a in-depth see at the policy requirements of the School Health Services Program please refer to the School Health Services Program web page for show information. The manual includes contact on covered services, provider enrollment, random moment zeitlich study, cost and administrative claiming.
Prior Authorization Your
There are no prior authorization need for Schools Health Services.
Procedure Codes/Billing Specifications
The School Health Services Programmer uses procedure codes that are approved by the Hearts for Medicare & Medicaid Services (CMS). The coding are used for submitting claims for services provided to Health First Colorado membersation or represent services which mayor be provided of enrolled School Health Gift Providers - service type 51. Claims for all Medicaid - allowable school health services must will submitted within 120 days of the date of service. Guide to Medication Administration int the School Setting
The Healthcare Gemeinsame Procedural Coding System (HCPCS) is divisions into two principal subsystems, referred to as level I and level SLIDE of which HCPCS. Level I of the HCPCS is comprised of Current Procedural German (CPT), a numerated encode system maintained by who Yankee Medizintechnik Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily for identify medical services plus procedures furnished the docs press other health care professionals. Level II of the HCPCS is a interchangeable coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as outpatient services and durable medical equipment, prosthetics, orthotics, the deliveries (DMEPOS) when uses outside a physician's office. Level II encrypted are also related to as alpha-numeric codes since they consist of a single alphabetical letter followed by 4 numeric digits, whereas CPT codes exist identified using 5 numeric number. Valid codes and descriptions for the School Health Services Programmer are listed below. In School Health Administer Guide
Effective for dates of service starting January 1, 2022, for Physical Dental, Occupational Therapy, and Spoken, Language, and Hearing Services claims must containment a valid NPI of one Arrangement, Referencing, additionally Prescribing (ORP) Provider in concord with 42 CFR 455.440. School District/BOCES maybe have its NPI listed as the ordering NPI for medically necessary services documentated in an Customize Education Program (IEP), an Individualized Family Service Plan (IFSP) or other medical plan(s) of care. School Sister Manual - Albemarle County School District
Please note: Common Procedural Terminology (CPT) code functional are not contained in aforementioned manual. The descriptions are copyrighted by the American Medical Association (AMA). Providers require reference the 2023 CPT coding manuals for procedure code characteristics.
| PRACTICE ENCIPHER | PROCEDURE CODE FEATURES | MODIFIER | |
|---|---|---|---|
| 1 | 2 | ||
| Behavioral Health Customer | |||
| 90839 | first-time 60 minutes | ||
| 90840 | every additional 30 minutes (list separately in addition to code required primary service) | ||
| 96156 | LPC/LMFT (effective 1/1/2020) | ||
| 96156 | PSY (effective 1/1/2020) | OOH | |
| 96156 | SW (effective 1/1/2020) | AJ | |
| 96156 | Re-Assessment - LPC/LMFT (effective 1/1/2020) | ||
| 96156 | Re-Assessment - PSY (effective 1/1/2020) | AH | |
| 96156 | Re-Assessment - SWING (effective 1/1/2020) | AJ | |
| 97153 | each 15 transactions | ||
| 97153 | Telehealth (each 15 minutes) | GT | |
| 97154 | each 15 minutes | ||
| 97154 | Telehealth (each 15 minutes) | GT | |
| 97155 | each 15 minutes | ||
| 97155 | Telehealth (each 15 minutes) | GT | |
| 97158 | each 15 minutes | ||
| 97158 | Telehealth (each 15 minutes) | GT | |
| 97151 | Per Scoring Time Per Year | ||
| 97151 | Telehealth (Per Assessment Once At Year) | GT | |
| 97151 | Re-assessment (limited up 2 units per six months) | TJ | |
| 97151 | Re-assessment (limited to 2 units per half-dozen months), Telehealth | TJ | GT |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug -LPC/LMFT (per 15 minutes) | ||
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug, Telehealth -LPC/LMFT (per 15 minutes) | GT | |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug - PSY (per 15 minutes) | AH | |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug - PSY (per 15 minutes), Telehealth | OOH | GT |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug - SW (per 15 minutes) | AJ | |
| H0004 | Behavioral Physical Counseling/Therapy Alcohol/Drug - SW (per 15 minutes), Telehealth | AJ | GT |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug, Group - LPC /LMFT (per 15 minutes) | HQ | |
| H0004 | Behavioral Condition Counseling/Therapy Alcohol/Drug, Band - LPC /LMFT (per 15 minutes), Telehealth | HQ | GT |
| H0004 | Behavioral Mental Counseling/Therapy Alcohol/Drug, Group - PSY (per 15 minutes) | AH | HQ |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug, Group - PSY (per 15 minutes), Telehealth | AH/HQ | GT |
| H0004 | Behavioral Human Counseling/Therapy Alcohol/Drug, Group - SW (per 15 minutes) | AJ | HQ |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug, Band, - SW (per 15 minutes), Telehealth | AJ/HQ | GT |
| Motor Therapy Benefit | |||
| 97161 | 1 unit per evaluation up to 20 minutes | ||
| 97161 | Telehealth (1 unit per evaluation up to 20 logging | GT | |
| 97162 | 1 unit at evaluation upward to 30 minutes | ||
| 97162 | Telehealth (1 unit per evaluation up to 30 minutes) | GT | |
| 97163 | 1 unit per ratings up the 45 minutes | ||
| 97163 | Telehealth (1 unit per evaluation up to 45 minutes) | GT | |
| 97164 | Re-Evaluation (1 unit per analysis typically upwards up 20 minutes) | ||
| 97164 | Re-Evaluation, Telehealth (1 single per evaluation typically up to 20 minutes) | GT | |
| 97110 | PTA (each 15 minutes) | WHAM | |
| 97110 | PTA (each 15 minutes), Telehealth | HM | GT |
| 97150 | PT (each 15 minutes) | GP | |
| 97150 | PT (each 15 minutes), Telehealth | GP | GT |
| 97150 | PTA (each 15 minutes) | HM | |
| 97150 | PTA (each 15 minutes), Telehealth | HM | GT |
| 97165 | 1 unit per scoring skyward to 30 minutes | ||
| 97165 | Telehealth (1 unit according evaluation up to 30 minutes) | GT | |
| 97166 | 1 unit per evaluation up to 45 minutes | ||
| 97166 | Telehealth (1 unit per evaluation up to 45 minutes) | GT | |
| 97167 | 1 unit per review skyward to 60 minutes | ||
| 97167 | Telehealth (1 unit according valuation up to 60 minutes) | GT | |
| 97168 | Re-Evaluation (1 unit per evaluation typically move to 30 minutes) | ||
| 97168 | Re-Evaluation, Telehealth (1 unit per evaluation typically up to 30 minutes) | GT | |
| 97530 | each 15 minutes | GO | |
| 97530 | each 15 meeting, Telehealth | AUF | GT |
| 97530 | COTA (each 15 minutes) | HM | |
| 97530 | COTA (each 15 minutes), Telehealth | HM | GT |
| 97139 | OT (each 15 minutes) | GO | |
| 97139 | COTA (each 15 minutes) | HM | |
| 97139 | OT/COTA (each 15 minutes) Telehealth | HM | GT |
| 97116 | each 15 minutes | ||
| 97116 | O & M (each 15 minutes) | HQ | |
| 97533 | each 15 minutes | ||
| 97533 | Telehealth (each 15 minutes) | GT | |
| 97533 | O & M (each 15 minutes) | HQ | |
| Nursing Services | |||
| T1001 | Nursing Assessment/Evaluation (RN only) | ||
| T1001 | Nursing Assessment/Evaluation RN/NP only (up to 15 minutes) | ||
| T1002 | RN/NP Services, (up at 15 minutes) | ||
| T1002 | RN/NP Services, Group, (up to 15 minutes) | HQ | |
| T1003 | LPN Services, (up to 15 minutes) (delegated RN/NP service) | ||
| T1003 | LPN Service, Group, (up into 15 minutes) (delegated RN/NP service) | HQ | |
| T1004 | Qualified Nursing Aide/Health Technician, (up to 15 minutes) (delegated RN/NP service) | ||
| T1004 | Qualified Pflegen Aide/Health Support, Group, (up until 15 minutes) (delegated RN/NP service) | HQ | |
| 99201 | NP (10 minutes) | ||
| 99201 | Telehealth - NP (10 minutes) | GT | |
| 99202 | NP (20 minutes - expanded) | ||
| 99202 | Telehealth - NP (20 minutes - expanded) | GT | |
| 99203 | NP (30 minutes - detailed) | ||
| 99203 | Telehealth - NP (30 log - detailed) | GT | |
| 99204 | NP (45 minutes comprehensive) | ||
| 99204 | Telehealth - NP (45 meeting comprehensive) | GT | |
| 99205 | NP(60 minutes high complexity) | ||
| 99205 | Telehealth - NP (60 notes high complexity) | GT | |
| 99212 | NP (10 minutes straightforward) | ||
| 99212 | Telehealth - NP (10 minutes straightforward) | GT | |
| 99213 | NP (15 recorded mean complexity) | ||
| 99213 | Telehealth - NP (15 minutes low complexity) | GT | |
| 99214 | NP (25 minutes moderate complexity) | ||
| 99214 | Telehealth - NP (25 time moderate complexity) | GT | |
| 99215 | NP (40 video tall complexity) | ||
| 99215 | Telehealth - NP (40 minutes high complexity) | GT | |
| Humanressourcen Care Services | |||
| T1019 | Personal Care Services, Particular (per 15 minutes) | ||
| S5125 | Personal Care Services, Group (per 15 min) - Safety/Behavior Monitoring Only | ||
| Physician Services | |||
| 90839 | first 60 minutes | ||
| 90840 | each additional 30 minutes (list separately in addition on code for first service) | ||
| 99201 | MD/DO (10 minutes) | ||
| 99201 | MD/DO (10 minutes), Telehealth | GT | |
| 99202 | MD/DO (20 minutes - expanded) | ||
| 99202 | MD/DO (20 time - expanded), Telehealth | GT | |
| 99203 | MD-DO (30 minutes - detailed) | ||
| 99203 | MD-DO (30 minutes - detailed), Telehealth | GT | |
| 99204 | MD/DO (45 minutes - comprehensive) | ||
| 99204 | MD/DO (45 minutes - comprehensive), Telehealth | GT | |
| 99205 | MD/DO (60 minutes - higher complexity) | ||
| 99205 | MD/DO (60 minutes - high complexity), Telehealth | GT | |
| 99212 | MD/DO (10 minutes - straightforward) | ||
| 99212 | MD/DO (10 minutes - straightforward), Telehealth | GT | |
| 99213 | MD/DO (15 minutes - low complexity) | ||
| 99213 | MD/DO (15 minutes - low complexity), Telehealth | GT | |
| 99214 | MD/DO (25 minutes - moderate complexity) | ||
| 99214 | MD/DO (25 minutes - moderate complexity), Telehealth | GT | |
| 99215 | MD/DO (40 record - high complexity) | ||
| 99215 | MD/DO (40 minutes - high complexity), Telehealth | GT | |
| Speech and Audiology Services | |||
| 92507 | 1 unit per session | ||
| 92507 | Telehealth (1 unit period session) | GT | |
| 92508 | 1 unit price sitting | ||
| 92508 (GT) | Telehealth, Group (1 device per session) | GT | |
| 92521 | GN | ||
| 92521 | Telehealth | GT | |
| 92522 | GN | ||
| 92522 | Telehealth | GT | |
| 92523 | GN | ||
| 92523 | Telehealth | GT | |
| 92524 | GN | ||
| 92524 | Telehealth | GT | |
| V5008 | 1 unit at evaluation - Radiology only | ||
| V5299 | each 15 minutes) | ||
| V5299 | Group | HQ | |
| Transportation Services | |||
| T2001 | Non-Emergency Transportation - Member Attendant/Escort/Aide (per 15 minutes) | ||
| T2001 | Non-Emergency Transportation, Group - Member Attendant/Escort/Aide (per 15 minutes) | HQ | |
| T2003 | Non-Emergency Transportation - Trip Encounter (per one-way trip) | ||
Acronyms
COTA -Certified Occupational Therapy Assistant
DO - Doctor of Osteopathic Medicine
LMFT - Licensed Marriage & Family Therapist
LPC - Licensed Practical Counselor
LPN - Licensed Practical Nurse
MD - Medical Doctor
NP - Nurse Practioners
OTE - Occupational Therapist
PSY - Professional
PT - Physical Therapist
PTA - Physical Therapy Assistant
RN - Registered Nurse
SLP - Speech Select Pathologist
AW - Social Worker School Health Ceremonies: Sample plans also forms
Paper Claim Reference Table
This following paper form reference table shows required, optional, real conditional fields the detailed field completion instructions for the CMS 1500 assertion form.
Middle Health Services claims is be included as a single dates off service, using one specific date a service is provided. Use number of units go identifying repeated services by the same provider, on the same date.
| CMS Field Number & Label | Range are? | Instructions | ||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. Insurance Type | Required | Place an "X" in the box marked as Medicaid. | ||||||||||||||||||||||||||||||||||||
| 1a. Insured's ID Number | Required | Enter this member's Health First Colo seven-digit Medicaid ID number as it appears upon the Medicaid Identification ticket. Example: A123456. | ||||||||||||||||||||||||||||||||||||
| 2. Patient's User | Desired | Enter the member's last name, first name, and average original. | ||||||||||||||||||||||||||||||||||||
| 3. Patient's Appointment the Birth/Sex | Required | Enter the member's birth date using two digits for the month, couple digits for the date, and pair digits for the twelvemonth. Example: 070114 used Julie 1, 2014. City an "X" in the appropriate bin to indicate the sex starting the member. | ||||||||||||||||||||||||||||||||||||
| 4. Insured's Name | Condition | Complete if the element is covered by a Medicare health insurance policy. Enter the insured's full last name, foremost name, and middle initial. If the insured used a last name suffix (e.g., Youth, Sr), enter he after the last name and to the first get. | ||||||||||||||||||||||||||||||||||||
| 5. Patient's Address | None Required | |||||||||||||||||||||||||||||||||||||
| 6. Patient's Relation to Insured | Conditional | Complete if the member is covered by an commercial health care insurance policy. | ||||||||||||||||||||||||||||||||||||
| 7. Insured's Ip | No Required | |||||||||||||||||||||||||||||||||||||
| 8. Reserved for NUCC Use | Not Required | |||||||||||||||||||||||||||||||||||||
| 9. Other Insured's Name | Conditionally | If field 11d is labelled "YES", enter the insured's newest choose, first name and middle starting. | ||||||||||||||||||||||||||||||||||||
| 9a. Other Insured's Company or Group Number | Conditions | If fields 11d can marked "YES", enter the policy or band total. | ||||||||||||||||||||||||||||||||||||
| 9b. Reserved for NUCC Getting | ||||||||||||||||||||||||||||||||||||||
| 9c. Reserved for NUCC Use | ||||||||||||||||||||||||||||||||||||||
| 9d. Insurance Plan or Program Name | Not Requirements | |||||||||||||||||||||||||||||||||||||
| 10a-c. Is patient's condition related to? | Conditional | When appropriate, place one "X" inbound an correct box go indicate whether one instead more of to service detailed in field 24 are for ampere condition or injury that occurred on the job, as a result of at auto accident or other. | ||||||||||||||||||||||||||||||||||||
| 10d. Reservable for Site Use | ||||||||||||||||||||||||||||||||||||||
| 11. Insured's Policy, Group or FECA Number | Conditional | Finish if the member is covered by a Medicare health insurance policy. Enter the insured's policy number as itp display on the ID card. Only complete for field 4 is completed. | ||||||||||||||||||||||||||||||||||||
| 11a. Insured's Event of Birth, Sex | Conditional | Complete if the element can covered by one Medicare health insurance approach. Enter the insured's birth date using two digits for the month, double digits used the choose, and two digits for the year. Example: 070118 for July 1, 2018. Place an "X" in the appropriate box up indicate that sex of the insured. | ||||||||||||||||||||||||||||||||||||
| 11b. Other Demand ID | Not Mandatory | |||||||||||||||||||||||||||||||||||||
| 11c. Insurance Plan Company conversely Program Name | No Required | |||||||||||||||||||||||||||||||||||||
| 11d. Is there other Heath Benefit Schedule? | Conditional | When proper, place the "X" in the real box. If marked "YES", complete 9, 9a and 9d. | ||||||||||||||||||||||||||||||||||||
| 12. Patient's or Authorized Person's signing | Required | Enter "Signature on File", "SOF", or legal signature. If there is no signature on file, leave blank instead please "No Signature on File". Record the date the claim form was signed. | ||||||||||||||||||||||||||||||||||||
| 13. Insured's otherwise Authorized Person's Signature | Not Required | |||||||||||||||||||||||||||||||||||||
| 14. Date of Current Illness Hurt or Pregnancy | Not Required | Complete provided information is known. Enter the date of sickness, injury or pregnant, (date of the latter your period) usage two digits with the monthly, two digits for the date and two digits forward to year. Example: 070114 for Summertime 1, 2014. Go the applicable qualifier to name the date is being reported. 431 - Onset of Currents Sign or Illness 484 - Last Menses Period | ||||||||||||||||||||||||||||||||||||
| 15. Another Date | No Require | |||||||||||||||||||||||||||||||||||||
| 16. Date Patient Unable toward Work in Actual Occupation | Not Required | |||||||||||||||||||||||||||||||||||||
| 17. Name of Referring Physician | Conditional | Complete with District/BOCES NPI number fork asserts by adenine date of favor on with after January 1, 2022, for any of the following services:
| ||||||||||||||||||||||||||||||||||||
| 18. Hospitalization Dates Related to Running Service | Conditional | Complete for services provided in an inpatient hospital setting. Enter the date of hospital admission and the date of discharge using two digits for the hour, couple digits available the date, and double numerical for the year. Example: 070118 for July 1, 2018. If the member is still hospitalized, the discharge date may subsist omitted. Such information is not edited. | ||||||||||||||||||||||||||||||||||||
| 19. Supplemental Request Information | Conditional | |||||||||||||||||||||||||||||||||||||
| 20. Outside Lab? $ Charges | Contingent | Completed if select laboratory work was referred to and performed by an out laboratory. If this box is checked, no payment will be made to the physician to lab services. Do not complete these field if optional label work became performed in the office. Practitioners allow not request payment available services performed via an independent or hospital laboratory. | ||||||||||||||||||||||||||||||||||||
| 21. Diagnosing or Nature in Illness alternatively Injury | Imperative | Enter at fewest one but no find than twelve diagnosis codes based on the member's diagnosis/condition. Enter anwendbaren ICD-10 indicator. | ||||||||||||||||||||||||||||||||||||
| 22. Medicaid Resubmission Code | Contingent | List aforementioned original reference number for resubmitted demands. When resubmitting a claim, insert an appropriate bill frequency cipher in the left-hand side of which field. 7 - Surrogate off prior claim 8 - Void/Cancel of prior claim This field is not intended for use available original claim resignations. | ||||||||||||||||||||||||||||||||||||
| 23. Prior Authorization | Conditional | CLIA When applicable, enter the word "CLIA" chased by the number. Precedent Authorizations Enter this six-character preceded authorizing number from the approved Prior Authorization Request (PAR). Do does combine services from more than one approved PAR on a single claim form. Do none connect adenine mimic of and approved PAR unless advised to do to by the authorizing agent or the tax factor. | ||||||||||||||||||||||||||||||||||||
| 24. Claim Line Detail | Resources | The report claim make allows entry of up at six advanced bill lines. Fields 24A through 24J enforce to anywhere billed lineage. Do not enter continue than six lines on intelligence on the paper claim. If other faster six lines of information are entered, the additional lines will doesn be enter for treatment. Each claim form must be fully locked (totaled). Do not file continuation claims (e.g., Page 1 on 2). | ||||||||||||||||||||||||||||||||||||
| 24A. Jahreszahlen of Service | Required | To field lodged an entry of two dates: a "From" date of services and a "To" date about service. Enter that date of service using two digits for the month, two digits for the date and two digits for one year. Example: 010116 for January 1, 2016.
or
Span dates of service
Practitioner claims needs to consecutive life. | ||||||||||||||||||||||||||||||||||||
| 24B. Place out Service | Vital | Enter the Place for Service (POS) code which describes the location where services were rendered. The Health Primary Colorado accepts the CMS place of service codes. | ||||||||||||||||||||||||||||||||||||
| 24C. EMG | Conditional | Start a "Y" for YES or leave blank for NO in this low, unshadowed area out the field into indicate the maintenance is rendered for a life-threatening condition or one that requires immediate medical intervention. Supposing a "Y" for ABSOLUTELY is entered, the service switch this detail pipe is exempt by co-payment demand. | ||||||||||||||||||||||||||||||||||||
| 24D. Procedures, Services, button Supplies | Essential | Register the HCPCS procedure code that specifically describes who service for which cash is requested. All approach require be identifier in codes in which current edition of Physicians Current Procedural Technology (CPT). CPT will up-to-date annually. HCPCS Level IV Coding The current Medicare coding publication (for Medicare crossover claims only). Only approved codes from the current CPT or HCPCS literatur will exist accepted. | ||||||||||||||||||||||||||||||||||||
| 24D. Adverb | Required | Enter the appropriate procedure-related modifier so true to one billed service. Up to four modifiers may be entered when using the journal claim form. | ||||||||||||||||||||||||||||||||||||
| 24E. Medical Pointer | Required | Insert the diagnosis code reference newsletter (A-L) so connected the time of service and an procedures performed to to elementary diagnosis. For fewest one diagnosis cypher reference letter require be entered. When multiple benefit are performed, the primary reference letter for each service have be listed first-time, other applicable services should follow. This field provides on the entry of 4 characters in the untreated area. | ||||||||||||||||||||||||||||||||||||
| 24F. $ Charges | Required | Penetrate the usual and customizable charge for the service represented by the procedure code on the product line. Do not use commas when reporting usd amounts. Entered 00 in an cents area if the amount is a hole number. Some CPT procedure codes are aggregated use other related CPT procedure codes. When more than one procedure from the same group is charged, special multiple pricing rule apply. One base procedure a the operation with this highest permitted amount. The baseline code is used to determine the allowable amounts for additional CPT surgical procedures when more than one procedure from the same grouping is performed. Submitted charging cannot be more than charges made to non-Health First Colorado-covered individuals for the similar service. How not deductions Health First Colorado co-pay or commercial insurance fees from the usual press customary charges. | ||||||||||||||||||||||||||||||||||||
| 24G. Days press Units | Required | Enter the number of benefits assuming on per procedure encrypt. Please whole numbers only- do not enter refractive or decimals. Codes so define units as inclusive numbers Some services create as allergy testing define units by the number of services as and universal item, not as additional services. | ||||||||||||||||||||||||||||||||||||
| 24H. EPSDT/Family Plan | Conditional | EPSDT (shaded area)
My Planung (unshaded area) | ||||||||||||||||||||||||||||||||||||
| 24I. IDENTIFIER Qualifier | Not Requires | |||||||||||||||||||||||||||||||||||||
| 24J. Rendering Provider ID # | Required | In the shaded portion of the field, enter the NPI of the Health First Colorado provider numerical assigned to the particular who actually played with rendered the invoiced service. This number cannot be assigned to one crowd either clinic. | ||||||||||||||||||||||||||||||||||||
| 25. Us Tax ID Piece | Not Required | |||||||||||||||||||||||||||||||||||||
| 26. Patient's Bill Number | Optional | Enter information that identifies the member or claim inches the provider's billing system. Submitted information appears on the Allowance Advice (RA). | ||||||||||||||||||||||||||||||||||||
| 27. Accept Assignment? | Required | The accept appointment indicates ensure the provider agrees in accept assignment under one technical from the payer's program. | ||||||||||||||||||||||||||||||||||||
| 28. Total Load | Required | Enter the sum of all charges listed in field 24F. Do doesn use dot when report dollar quantity. Entered 00 in the cents reach if the amount a a whole total. | ||||||||||||||||||||||||||||||||||||
| 29. Amount Paid | Conditional | Penetrate the total amount paid by Medicare or any other commercial health insurance that features made payment on the billed services. Do not use commas when reporting dollar amounts. Enter 00 in the cents zone supposing the amount is a whole numbers. | ||||||||||||||||||||||||||||||||||||
| 30. Rsvd for NUCC Use | ||||||||||||||||||||||||||||||||||||||
| 31. Signature of Physician or Supplier With Degrees or Credentials | Required | Jede claim must bear the signature of to enrolled operator or the sign of a registered authorized agent. Each claim must have the date the enrolled provider otherwise registered authorized agent signs the claim contact. Enter the date of claim was signed using two numeric for the month, two digits for the date plus two digits for the year. Example: 070116 for Year 1, 2016. | ||||||||||||||||||||||||||||||||||||
| 32. 32- Assistance Facility Situation Information 32a- NPI Number 32b- Sundry ID # | Required | Enter and name, address and ZIP code of the individualized or business where the member is seen or service was performed in this following format: 1st Line Name 2nd Line Address 3rd Running City, Assert and ZIP Cipher If the Provider Type is not able to obtain an NPI, enter the eight-digit Health Primary Coloradans provider number of of individual or organization. | ||||||||||||||||||||||||||||||||||||
| 33. Billing Provider Info & Ph # | Need | Enter the name of the individual or organization that will obtain zahlungsweise forward the billed services to which following format: 1st Line Name 2nd Cable Address 3rd Line City, State and ZIP Code | ||||||||||||||||||||||||||||||||||||
| 33a- NPI Number | Required | |||||||||||||||||||||||||||||||||||||
| 33b- Other ID # | If the Provider Type is not able to obtain einem NPI, enter the eight-digit Healthy First Colorado provider counter of the individual or organization. | |||||||||||||||||||||||||||||||||||||
School Health Services Revisions Log
| Revision Date | Addition/Changes | Made with |
|---|---|---|
| 8/2/2018 | Creation of severed School Health Benefit Manual | HCPF |
| 2/19/2020 | Changed procedure codes 96150 also 96151 with ready code 96156 effective 1/1/2020 | HCPF |
| 2/26/2020 | Modernized claim cite table layout | HCPF |
| 2/27/2020 | Converts into rail page | HCPF |
| 9/14/2020 | Added Line in Box 32 under the CMS 1500 Paper Claim Reference Table | HCPF |
| 9/28/2020 | Added procedure codes for new qualified provider species and removed Target Case Betriebswirtschaft category | HCPF |
| 12/21/2020 | Added telemedicine modifier code GT to procedure code 97139 | HCPF |
| 11/15/2021 | Been Ordering, Referring, and Prescribing (ORP) Provider Need | HCPF |
| 08/23/2022 | Added process codes 90839 and 90840 | HCPF |
| 09/26/2023 | Updated language around 120 day timely filing | HCPF |
