Billing Manual for Community Care Network Providers

Missing Quantity Institutional Claim - Detail reject error code/description =MCN0006/Invalid Quantity Institutional Claim Missing Procedure Code – Detail reject error code/description = MCN0007/MissingProcedure Code Missing Subscriber Last Name - Detail reject error code/description =CN0008/Missing Subscriber Last Name Invalid Charge Amount - Detail reject error code/description = MCN0009/InvalidCharge Amount Missing Subscriber ID # - Detail reject error code/description = MCN0010/MissingSubscriber ID # Missing Place of Service - Detail reject error code/description = MCN0011/Place ofService Missing Invalid Diagnosis Code – Detail error code/description = CLM0314/Non ValidDiagnosis, or missing a required Diagnosis CodeGeneral Claims Submission RulesAll claim forms must contain: Member ID number (10 digit MA Recipient ID.) NPI number. ICD-9 diagnosis codes: Behavioral Health Diagnosis Range 290-319 billed to the 5 th digit, if applicable.Do Not Add Zero’s. Diagnosis code 799.9 is not an appropriate or acceptable diagnosis unless thediagnosis code is billed with an acceptable procedure code. Please refer toProvider Alert #10 8-18-2009-Appropriate Use of Diagnosis Code 799.9, locatedonline at www.ccbh.com in PDF format. Procedure codes which appear on the Community Care Fee Schedule. “Billing Units” as defined on the Community Care Fee Schedule. The date span (to-from) should be equal to the total number of units billed for theroom and board revenue codes. Data must be within the lines of the applicable claim form box. Font should be Arial and the size should be between 10 and 12. Acceptable paper claim forms include the UB04 for institutional claims and theCMS1500 for professional claims.Paper claims must be completed as outlined in this manual or the claims cannot bescanned into the claims processing system. It is preferred that paper claims besubmitted on the standard red and white forms, as black grid lines (copied forms) willinterfere with the scanning process. Claims that are not completed correctly may bedenied. The Explanation of Payment (EOP) for the claim in question will include a denialcode that indicates why the claim could not be paid.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 105