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- 42 CFR 424.32
ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-424/subpart-C/section 424.32 - 837P Health Care Claim: Professional Implementation Guide
x12.org/products/technical-reports - Administrative Simplification Act
congress.gov/107/plaws/publ105/PLAW-107publ105.pdf - Administrative Simplification Compliance Act Self Assessment
CMS.gov/medicare/coding-billing/electronic-billing/administrative-simplification-compliance-act-self-assessment - Administrative Simplification Compliance Act Waiver Application
CMS.gov/medicare/coding-billing/electronic-billing/administrative-simplification-compliance-act-waiver-application - Alpha-Numeric HCPCS
CMS.gov/medicare/coding-billing/healthcare-common-procedure-system/alpha-numeric - American Dental Association (ADA)
ada.org/resources/practice - American Medical Association (AMA) CPT Codebook
ama-assn.org/practice-management/ama-store - American National Standards Institute (ANSI)
ansi.org - ASC X12
X12.org - Beneficiaries Dually Eligible for Medicare & Medicaid fact sheet
CMS.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/Medicare_Beneficiaries_Dual_Eligibles_At_a_Glance.pdf - Complying with Medicare Signature Requirements fact sheet
CMS.gov/files/document/mln905364-complying-medicare-signature-requirements.pdf - Comprehensive Error Rate Testing (CERT)
CMS.gov/data-research/monitoring-programs/improper-payment-measurement-programs/comprehensive-error-rate-testing-cert - Coordination of Benefits Agreement
CMS.gov/medicare/coordination-benefits-recovery/coba-trading-partners/agreement - Diagnosis Coding: Using the ICD-10-CM web-based training (WBT) course
CMS.gov/Outreach-and-Education/MLN/WBT/MLN6447308-ICD-10-CM/icd10cm/index.html - Electronic Billing & EDI Transactions
CMS.gov/medicare/coding-billing/electronic-billing - Electronic Claims Attachments
CMS.gov/medicare/coding-billing/electronic-billing/electronic-claims-attachments - Evaluation and Management Services Guide
CMS.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf - Form CMS-855B
CMS.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855b.pdf - Form CMS-855I
CMS.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855i.pdf - Form CMS-855O
CMS.gov/Medicare/CMS-Forms/CMS-Forms/downloads/CMS855O.pdf - Form CMS-855S
CMS.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855s.pdf - Form CMS-1500
CMS.gov/medicare/cms-forms/cms-forms/downloads/cms1500.pdf - HCPCS
CMS.gov/medicare/coding-billing/healthcare-common-procedure-system - HIPAA and Administrative Simplification
CMS.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/hipaa - HIPAA Eligibility Transaction System (HETS) Health Care Eligibility Benefit Inquiry and Response (270/271) 5010 Companion Guide
cms.gov/files/document/r2023q100-hets-270/271-companion-guide-v10-29.pdf - How to Use the Medicare National Correct Coding Initiative (NCCI) Tools booklet
CMS.gov/files/document/mln901346-how-use-medicare-ncci-tools.pdf - ICD-10 Resources
CMS.gov/medicare/coding-billing/icd-10-codes
CDC.gov/nchs/icd/icd-10-cm/files.html?CDC_AAref_Val=https://www.cdc.gov/nchs/icd/comprehesive-listing-of-icd-10-cm-files.htm - Look Up a ZIP Code
tools.usps.com/go/ZipLookupAction!input.action - MA Claims Processing Contacts
CMS.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/ma-claims-processing-contacts - MAC Websites, Secure Internet Portals, & Electronic Mailing Lists
CMS.gov/MAC-info - Medicare Billing: CMS-1500 & 837P booklet
CMS.gov/files/document/mln006976-medicare-billing-cms-1500-837p.pdf - Medicare Claims Processing Manual
CMS.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912 - Medicare Demonstration Projects & Evaluation Reports
CMS.gov/medicare/demonstration-projects/demoprojectsevalrpts - Medicare EDI Helplines
CMS.gov/Medicare/Billing/ElectronicBillingEDITrans/Downloads/EDIHelplines.pdf - Medicare Fee-for-Service Companion Guides
CMS.gov/medicare/coding-billing/electronic-billing/medicare-fee-for-service-compainion-guides - Medicare Fraud & Abuse: Prevent, Detect, Report booklet
CMS.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf - Medicare Fraud & Abuse: Prevent, Detect, Report WBT
CMS.gov/Outreach-and-Education/MLN/WBT/MedicareFraudandAbuse/FraudandAbuse/story.html - Medicare General Information, Eligibility, and Entitlement, Chapter 5
CMS.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/ge101c05.pdf - Medicare Learning Network®
CMS.gov/training-education/medicare-learning-network/resources-training - Medicare National Correct Coding Initiative Edits
CMS.gov/medicare/coding-billing/ncci-medicare - Medicare Overpayments fact sheet
CMS.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/OverpaymentBrochure508-09.pdf - Medicare Program Integrity Manual, Chapter 4
CMS.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c04.pdf - Medicare Secondary Payer
CMS.gov/medicare/coordination-benefits-recovery/overview/secondary-payer - Medicare Secondary Payer booklet
CMS.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MSP_Fact_Sheet.pdf - Medicare Secondary Payer Manual
CMS.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs- Items/CMS019017 - MS-DRG Classifications and Software
CMS.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software - National Plan and Provider Enumeration System (NPPES)
nppes.cms.hhs.gov/# - National Provider Identifier Standard (NPI) webpage
CMS.gov/regulations-and-guidance/administrative-simplification/nationalprovidentstand - National Uniform Billing Committee (NUBC)
nubc.org - Non-Group Health Plan Recovery
CMS.gov/medicare/coordination-benefits-recovery/overview/non-group-health-plan-recovery - NPI Application/Update Form (CMS - 10114)
CMS.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS10114.pdf - NPI Data Dissemination
CMS.gov/medicare/regulations-guidance/administrative-simplification/data-dissemination - NPPES Downloadable File
download.cms.gov/nppes/NPI_Files.html - Order and Referring Tool
data.cms.gov/provider-characteristics/medicare-provider-supplier-enrollment/order-and-referring - Outpatient Code Editor (OCE)
CMS.gov/medicare/coding-billing/outpatient-code-editor - Provider Compliance
CMS.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ProviderCompliance - Provider-Enrollment and Certification - Ordering & Certifying
CMS.gov/medicare/enrollment-renewal/providers-suppliers/chain-ownership-system-pecos/ordering-certifying - Washington Publishing Company (WPC)
wpc-edi.com - Workgroup for Electronic Data Interchange (WEDI)
wedi.org