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Are the subscriber and the patient the same person? What is the code for the patients relationship to the insured? What is the claim filing

  1. Are the subscriber and the patient the same person?
  2. What is the code for the patients relationship to the insured?
  3. What is the claim filing indicator code?

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  • Claim control numbers are created by adding the eight-digit date to the patient account number, as in PORCEJE0-01012016.
  • A copayment of $15 is collected from each Oxford PPO patient at the time of the visit. A copayment of $10 is collected for Oxford HMO.
  • The practice uses NDC as its clearinghouse to transmit claims.
  • The necessary data for the payer and the clearinghouse are stored in the programs databases.

Provider Information

Billing Provider

Valley Associates, PC NPI 1476543215

Address

1400 West Center Street Toledo, OH 43601-0213

Telephone

555-967-0303

Employer ID Number

16-1234567

Rendering Provider

Christopher M. Connolly, MD

NPI

8877365552

Oxford PPO Provider Number

1011

Oxford HMO Provider Number

2567

Assignment

Accepts

Case: From the Patient Information Form:

Name

Kalpesh Shah

Sex

M

Birth Date

01/21/2005

Assignment of Benefits

Y

Signature on File

Y

Primary Insurance

Insured

Raj Shah

Patient Relationship to Insured

Son

Insureds Birth Date

02/16/1976

Insureds Sex

M

Insureds Address

1433 Third Avenue, Cleveland, OH 44101-1234

Insureds Employer

Cleveland Savings Bank

Insurance Policy Group Number

G0904

Insurance Plan/ Program Name

Oxford Freedom PPO

Member ID

3302112090X

Encounter Form

See below.

VALLEY ASSOCIATES, PC Christopher M. Connolly, MD Internal Medicine 555-967-0303 NPI 8877365552 PATIENT NAME APPT. DATE/TIME 10/4/2018 Shah, Kalpesh 3:30 pm PATIENT NO 1. H61.23 cerumen in ear SHAHKALO 2. 3. 4. DESCRIPTION CPT | FEE | DESCRIPTION OFFICE VISITS PROCEDURES New Patient Diagnostic Anoscopy 46600 LI Problem Focused 99201 ECG Complete 93000 10060 99202 LII Expanded &D, Abscess LIll Detailed 99203 Pap Smear 88150 LIV Comp./Mod 99204 Removal of Cerumen V69210 63 17000 LV Comp./High 99205 Removal 1 Lesion 17003 Established Patient Removal 2-14 Lesions 17004 99211 30Removal 15+ Lesions LI Minimum LII Problem Focused 99212 Rhythm ECG w/Report 93040 93041 LIII Expanded 99213 Rhythm ECG w/Tracing LIV Detailed 99214 Sigmoidosco 45330 LV Co 9215

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