DMAS-30 (Title 18) Common Billing Errors
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Transcript DMAS-30 (Title 18) Common Billing Errors
MEDICARE
DEDUCTIBLE AND COINSURANCE
Common Billing Errors
TITLE XVIII
(DMAS-30)
Department of Medical
Assistance Services
February 2010
www.dmas.virginia.gov
Medicaid Primary
If problems are encountered with the Medicare
Crossover claim process, the DMAS-30 invoice
form should be completed and forwarded to:
Practitioner
Department of Medical Assistance Services
P. O. Box 27444
Richmond, VA 23261-7444
Title XVIII Common Mistakes
Locator 7 - Other Coverage
Locator 8 - Type Coverage
Locator 17- Charges to Medicare
Locator 18- Allowed By Medicare
Locator 19- Paid By Medicare
Locator 20- Deductible
Locator 21- Coinsurance
Locator 22- Paid By Carrier Other Than
Medicare
Locator 23- Patient Pay Amount (LTC Only)
Title XVIII- Block 01
01 Billing Provider Number
Enter the provider’s billing or group NPI.
Title XVIII- Block 06
06 Rendering Provider Number
Enter the rendering provider’s NPI.
Block 7
Patient only has Medicare and Medicaid
coverage- Check 2
Patient has Medicare coverage primary and a
secondary plan which has paid on the deductible
or coinsurance amount- Check 3 and write the
amount paid in Block 22.
Patient has Medicare primary and a secondary
plan which has denied the service, or applied the
coinsurance to deductible- Check 5 and attach
the secondary carrier’s Explanation of Benefits.
Title XVIII- Block 07
07 Primary Carrier Information Other Than
Medicare
2 No Other Coverage
3 Billed and Paid
5 Billed No Coverage
Title XVIII- Block 08
08
Type Of
Coverage
Medicare
B
Type Coverage MedicareMark type of coverage “B”.
Title XVIII- Block 17
17 Charges To Medicare
Block 17: Charges to Medicare- Enter the
total charges submitted to Medicare.
Title XVIII- Block 18
18 Allowed By Medicare
Block 18: Allowed by Medicare- Enter the
amount of the charges allowed by Medicare.
Title XVIII- Block 19
19 Paid By Medicare
Block 19: Paid by Medicare- Enter the
amount paid by Medicare (taken from the
EOB).
Title XVIII- Block 20
20 Deductible
Block 20: Deductible- Enter the amount of the
deductible (taken from the Medicare EOB).
Title XVIII- Block 21
21 Co-Insurance
Block 21: Coinsurance - Enter the amount of
the coinsurance (taken from the Medicare
EOB).
Title XVIII- Block 22
22 Paid By Carrier Other Than
Medicare
Block 22: Paid by Carrier Other Than MedicareEnter the payment received from the secondary
carrier (other than Medicare). If Code 3 is marked
in Block 7, enter an amount in this block.
(Do not include the Medicare payment.)
Title XVIII- Block 23
23 Patient Pay Amt. LTC Only
Block 23: Patient Pay Amount, LTC Only-
Leave Blank.
TITLE XVIII- Adjustment Invoice
DMAS-31
Block 1
Adjustment/Void
Check the appropriate block
Block 2
Billing Provider Number
Enter the NPI of the billing provider
Block 6
Rendering Provider Number
Enter the NPI of the rendering provider
Block 2A Reference Number
Enter the ICN number taken from the
Remittance Voucher for the line of payment need
adjustment.
TITLE XVIII- Adjustment Invoice
Blocks 3-20
Refer to instructions for the DMAS-31 for the
completion of these blocks.
Remarks
This section of the invoice should be used to give a
brief explanation of the change needed.
Signature
Signature of the provider or agent and the date
signed.
THANK YOU
Department of Medical Assistance
Services
www.dmas.virginia.gov