09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare

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and the doctor was listed. We know this doctor by her published name at the university but http://www.wpsmedicare.com she’s in the PECOS or the NPPES with her maiden name and her last name there. When we searched for her last name, it didn’t come up because it was in there as her maiden name. And sometimes if you have MD, that doesn’t work. And sometimes it does work and maybe you know about these problems or don’t know about these problems, but those are the types of reasons why we can’t find the referring doctor even in the NPPES because the names and the search engines don’t work right. Mary Muchow: Richard Farley: Mary Muchow: Richard Farley: Mary Muchow: Richard Farley: Mary Muchow: Operator: I would pick up the phone and call that physician and ask them for that information. If that physician is referring patients to your office and doing business with you, then he or she should be providing that information for you or make it readily available for you. OK. I don’t want to say their name but it’s like McDonalds kind of name where – do you put a space between the C and the D or do you not And it’s really hard sometimes so if you could find where the official list is because we found several lists in Medicare and NPPES. Is it with the space, without the space, with the period, without the period Unfortunately, a lot of that is going to depend on how they fill out the paperwork when they request their National Provider Identifier. The NPI contractor does have a searchable database. But again, depending on how that individual or healthcare provider or entity has gone to the NPI contractor and filled out paperwork and how, someone from that contractor indeed entered it into their database it might vary. The best bet is to go to that provider that you’re doing business with and ask them for their NPI. Tell them that you need that information to support the claim for the service that they referred to your office. OK. Yes, I mean, we have the NPI. It’s just that you also have to put in the name just right. But in any event, OK, we’ll look for that. Well, on the claim form, it’s going to be driven by the NPI that you entered into the appropriate item number on a paper claim or the corresponding electronic field for an electronic formatted claim. OK. Thanks. You’re welcome. Your next question comes from the line of Colleen Kelleher. Colleen Kelleher: Hi, I have just one question. Are remittance advices sent to providers who do not accept assignment and if so, how often Mary Muchow: We’re going to follow up on that one, Colleen. If you can give your telephone number, please. Colleen Kelleher: Sure. Area code (515) 226-7423. I have asked this at customer service and I’ve received conflicting information, so I’d just like the straight answer. 22
Mary Muchow: Colleen Kelleher: Thank you. OK. We will indeed follow up on that, Colleen. http://www.wpsmedicare.com Operator: Cathy Smith: Mary Muchow: Cathy Smith: Mary Muchow: Cathy Smith: Mary Muchow: Cathy Smith: Mary Muchow: Cathy Smith: Mary Muchow: Cathy Smith: Mary Muchow: Operator: Mary Muchow: Operator: Mary Muchow: You have a follow up question from the line of Cathy Smith. Hello. I had asked the question earlier about take-backs and I do have a remit in front of me now. I just wanted to follow up on one more question. This particular one only has a provider adjustment amount and then we do have the FB for the forwarding balance. However, there’s also mention in the remit on the bottom of this remit, something that I’m not familiar with, the PLB04 and PLB03. Can you explain what that is I’m not familiar with that. I can explain what a forwarding balance is. We will get that out of the way first. The forwarding balance… I understand the forwarding balance. I’m just unsure about a negative value with PLB04 or PLB03. Is the forwarding balance amount the same as the negative that you’re seeing of the PLB03 or 04 So that’s what I’m not familiar with. I just am not familiar with that, the PLB04 and 03 what that means. Is it the same as the forwarding balance Based on the recommendations made in the room, they’re suggesting that you would call customer service and they would be able to provide that information when they pull up the claim information. OK. So give them a call, they’ll be happy to help you. OK. So is there a particular number if we got questions on take-backs on the remit or do we just call the regular customer service line It would be the regular toll-free customer service line for providers. OK, thank you. You’re welcome. And there are no further questions at this time. OK. Excuse me; you have a question from the line of Janine Hone. Hi, Janine. 23
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09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare

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