Outpatient/office physical, speech, and occupational therapy claim form requirements

Beginning with dates of service April 1, 2019, we will implement various hospital edits in support of the Place of Service and Evaluation and Management reimbursement policy and the Maine Statute MRSA 24-A, Chapter 18, §1912, Standardized Claim Forms, which addresses the claim form billing requirements for professional services.

 

Professional services affiliated with a hospital that are rendered on or off the hospital campus, including those rendered in the outpatient hospital setting, must be billed on the CMS 1500 claim form.  Effective April 1, 2019, additional edits will be applied to the physical, occupational, and speech therapy (PT, OT, and ST) revenue codes (420 – 449).  These services will no longer be allowed on the UB-04 claim form.

 

Medicare Advantage and Medicare Supplemental plans are excluded.

 

What do I need to do to be ready?

In preparation, hospitals whose professional PT, OT, ST providers are not already Anthem approved and credentialed should follow one of the steps below to begin the process of enrolling your professional providers:

 

• For enrollment of < 25 providers, complete the online New Provider Application for each individual provider; or
• For enrollment of ≥ 25 providers, complete the Professional Roster Template.

 

Any questions regarding the enrollment process should be referred to the Provider Service Center at 800-832-6011.