Institutional claims definition

Institutional claims means claims for services that are submitted by institutional providers on a CMS Form 1450 or ANSI Accredited Standards Committee (ASC) X12 institutional claim format. These claims may be paid from either the Medicare Part A or Part B trust fund.
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Examples of Institutional claims in a sentence

  • Institutional claims for advanced imaging services provided during a member's inpatient hospital stay are automatically exempt from PA requirements.

  • EDS Acronyms 1.0 Introduction 1.1 ScopeThe CMS Encounter Data System (EDS) 837-I Companion Guide addresses how MAOs and other entities conduct Institutional claims Health Information Portability and Accountability Act (HIPAA) standard electronic transactions with CMS.

  • With this option, you can submit each claim directly on the website, the member and provider information are verified, and you receive a claim number right away.Batch Claim Submission: If you have to submit Institutional claims (submitted on a UB-92 or UB-04 form), and/or if you have a larger volume of Professional Claims, you can select Batch Claim submission.

  • Institutional claims for services not related to the terminal illness would otherwise be the responsibility of another geographically assigned Medicare contractor.

  • Professional and Institutional claims received electronically or on paper with dates of service on or after October 1, 2015 must use ICD-10 diagnosis codes.

  • For claims entered via the web:Claims headers were updated to accept ordering or referring Provider ID and name for Dental and Institutional claims and the referring provider’s name for Professional claims.

  • Claims must be submitted electronically either through HIPAA Compliant Transaction Sets 820 – Premium Payment, 834 – Member Enrollment and Eligibility Maintenance, 835 – Remittance Advice, 837P – Professional claims, 837I – Institutional claims, or the LME/PIHP’s secure web based billing system.

  • Institutional claims subject to the CHAMPUS DRG-based reimburse- ment method or a CHAMPUS-deter- mined all-inclusive rate reimburse- ment method, may be submitted only after the beneficiary has been dis- charged or transferred from the insti- tutional provider’s facility or program.

  • Test files for Professional and/or Institutional claims provided to us by the trading partner.

  • EDS Acronyms 1.0 Introduction1.1 ScopeThe CMS Encounter Data System (EDS) 837-I Companion Guide addresses how MAOs and other entities conduct Institutional claims Health Information Portability and Accountability Act (HIPAA) standard electronic transactions with CMS.

Related to Institutional claims

  • Institutional Client means a major commercial bank, corporation, insurance company, or substantially similar institution, which, as a substantial part of its business operations, purchases or sells securities and makes use of custodial services.

  • Institutional use means use within the lines of, or on property necessary for the operation of buildings such as hospitals, schools, libraries, auditoriums, and office complexes.

  • Institutional control means the continued surveillance, monitoring, and care of the disposal site after site closure and stabilization to insure the protection of the public health, safety, and welfare, and the

  • Institutional pharmacy means the physical portion of an institutional facility that is engaged in the compounding, dispensing, and distribution of drugs, devices, and other materials, hereinafter referred to as ‘drugs’, used in the diagnosis and treatment of injury, illness, and disease and which is permitted by the State Board of Pharmacy.

  • Environmental Claims means any and all administrative, regulatory or judicial actions, suits, demands, demand letters, claims, liens, notices of noncompliance or violation, investigations or proceedings relating in any way to any Environmental Law.

  • Institutional Controls or “ICs” shall mean Proprietary Controls and state or local laws, regulations, ordinances, zoning restrictions, or other governmental controls or notices that: (a) limit land, water, or other resource use to minimize the potential for human exposure to Waste Material at or in connection with the Site; (b) limit land, water, or other resource use to implement, ensure non-interference with, or ensure the protectiveness of the RA; and/or (c) provide information intended to modify or guide human behavior at or in connection with the Site.

  • Institutional facility means an organization whose primary purpose is to provide a physical environment for patients to obtain health care services and shall not include those places where physicians, dentists, veterinarians, or other practitioners, who are duly licensed, engage in private practice.

  • Professional Claim means an Administrative Claim of a Professional for compensation for services rendered or reimbursement of costs, expenses, or other charges and disbursements incurred relating to services rendered or expenses incurred after the Petition Date and prior to and including the Confirmation Date.

  • Institutionalized means a person who is located voluntarily or involuntarily in a hospital, medical treatment facility, nursing home, acute care facility, or mental hospital.

  • Insolvency Proceedings means bankruptcy, liquidation or other collective judicial or administrative proceedings, including interim proceedings, in which the assets and affairs of the debtor are subject to control or supervision by a court for the purposes of reorganisation or liquidation;

  • Adjudicative proceeding means the procedure to be followed in contested cases, as set forth in RSA 541-A:31 through RSA 541-A:36.

  • Institutional Review Board or “IRB” means, in accordance with 45 C.F.R. Part 46, 21 C.F.R. part 56, and other applicable regulations, an independent body comprising medical, scientific, and nonscientific members, whose responsibility is to ensure the protection of the rights, safety, and well-being of the Human Subjects involved in a study.

  • Institutional Accredited Investors Institutions that are “accredited investors” within the meaning of Rule 501(a) (1), (2), (3) or (7) of Regulation D under the Act or any entity all of the equity owners of which are such institutions.

  • Pending Claims shall have the meaning set forth in Section 7.1(e).

  • Institutional Investors means any regulated investment company, segregated asset account, foreign investment company, common trust fund, group trust or other investment arrangement, whether organized within or without the United States of America.

  • Institutional Lender means one or more commercial or savings banks, savings and loan associations, trust companies, credit unions, industrial loan associations, insurance companies, pension funds, or business trusts including but not limited to real estate investment trusts, any other lender regularly engaged in financing the purchase, construction, or improvement of real estate, or any assignee of loans made by such a lender, or any combination of any of the foregoing entities.

  • CCAA Proceedings means the proceedings commenced by the Applicant under the CCAA as contemplated by the Initial Order;

  • relevant proceedings means proceedings for contempt of court or proceedings under Schedule 2 to the Anti-social Behaviour, Crime and Policing Act 2014;

  • foreign proceeding means a collective judicial or administrative proceeding in a foreign State, including an interim proceeding, pursuant to a law relating to insolvency in which proceeding the assets and affairs of the debtor are subject to control or supervision by a foreign court, for the purpose of reorganization or liquidation;

  • criminal proceedings means criminal proceedings in relation to which the strict rules of evidence apply;

  • Institutional fund means a fund held by an institution exclusively for charitable purposes. The term does not include:

  • Insolvency or Liquidation Proceeding means, with respect to any Person, any liquidation, dissolution or winding up of such Person, or any bankruptcy, reorganization, insolvency, receivership or similar proceeding with respect to such Person, whether voluntary or involuntary.

  • Alternate Judgment means a form of final judgment that may be entered by the Court herein but in a form other than the form of Judgment provided for in this Stipulation.

  • Institutional Accredited Investor Certificate means a certificate substantially in the form of Exhibit G hereto.

  • Institutional Accredited Investor means an institution that is an "accredited investor" as defined in Rule 501(a)(1), (2), (3) or (7) under the Securities Act.

  • Environmental Proceedings means any judicial or administrative proceedings arising from or in any way associated with any Environmental Requirement.