Customer Service Frequently Asked Questions
North Carolina - Fourth Quarter 2005
- How do I sign up for the electronic funds transfer (EFT)?
- Why are my lab charges denying for the CLIA number?
- Where can I obtain the new ICD-9 codes for 2005?
- Where do I find information regarding the CCI Bundling Table?
- My claims for "new patient" exams are being denied with remark code B18. When is it appropriate to bill for this particular service?
- How do I sign up for the electronic
funds transfer (EFT)?
A. Please contact our Provider Enrollment Department for more information and to sign up for EFT. Their toll-free number is 1.866.520.4007. - Why are my lab charges denying for
the CLIA number?
A. CIGNA Medicare will deny services billed by providers that do not meet the CLIA requirements. The most common reasons for denials are:- Provider is submitting services not covered by its CLIA certificate
- Provider is submitting for services rendered outside of the effective date
- Provider does not have a CLIA number
The carriers do not have the responsibility for updating and maintaining CLIA certification records. The CLIA office is the state agency responsible for CLIA certification issues, such as issuing certificates and requesting updates to the necessary records. If your services denied for any of the reasons above and/or you have questions regarding your CLIA certification, you may wish to contact:
CLIA Certification
PO Box 29530
Raleigh , NC 27626
Telephone: 919-733-3032 - Where can I obtain the new ICD-9 codes
for 2005?
A. After the ICD-9 codes are published in the Federal Register, CMS places the new, revised, and discontinued codes on the following web site: http://www.cms.hhs.gov/medlearn/icd9code.asp. Also, providers can purchase a new ICD-9 book or CD-ROM on an annual basis. - Where do I find information regarding
the CCI Bundling Table?
A. The National Correct Coding Initiative was developed by CMS to promote national correct coding methodologies and control improper billing. The CCI Table is updated quarterly. The CCI Table and Policy Manual can be found on the CMS website at: http://www.cms.hhs.gov/physicians/cciedits/. - My claims for "new patient" exams
are being denied with remark code B18. When is it appropriate to bill
for this particular service?
A. The definition of a new patient examination reads:New and Established Patient
Solely for the purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by a physician and reported by a specific CPT code(s). A new patient visit is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.
We have found that some claims billed for new patient exams (99201-99205) may have been denied in error. If you have received erroneous denials for new patient exams that meet the criteria listed above, we will adjust claims brought to our attention.
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