Billing : Forms, Military Unique
Health Plan and Policy Billing GuidelinesThere are several health coverage policies and plans to which cost recovery programs can submit claims. Claim formats that are used in the Military Health System (MHS) are based on encounter services provided, payer requirements, and Service and National Capital Region Medical Directorate (NCR MD) billing policies. The U.S. Government may not collect more than the total charge of medical care from any one source or combination of sources. If total payment received exceeds the amount billed, the MTF must refund the overage to the payer. The table below contains claim format guidelines for each UBO Cost Recovery Program.
Institutional – Hospital charges (routine service charges associated with the hospital stay and ancillary charges).
Professional – Provider charges (professional services provided by physicians and certain services provided by physicians and other providers).
|Health Plan/Policy||Institutional||Billing Format||Professional||Billing Format||Cost Recovery Program|
|Private Insurance Policy||YES||837I/UB-04||YES||837P/CMS 1500||TPC, MSA, MAC|
|Employer Group Health Plan||YES||837I/UB-04||YES||837P/CMS 1500||TPC, MSA, MAC|
|High Deductible Health Plan (HDHP)||YES||837I/UB-04||YES||837P/CMS 1500||N/A|
|Health Savings Account (HSA)||NO||N/A||NO||N/A||N/A|
|Health Reimbursement Account (HRA)||NO||N/A||NO||N/A||N/A|
|Flexible Spending Account (FSA)||NO||N/A||NO||N/A||N/A|
|Association or Organization Health Plan||YES||837I/UB-04||YES||837P/CMS 1500||MAC|
|No-Fault Automobile Insurance||YES||837I/UB-04||YES||837P/CMS 1500||MAC|
|Third-Party Automobile Liability (Tort Claim)||YES||837I/UB-04||YES||837P/CMS 1500||MSA|
|Medicare Supplemental Plan||YES||837I/UB-04||YES||837P/CMS 1500||MSA|
|Workers' Compensation Plan (Nonfederal Employee)||YES||837I/UB-04||YES||837P/CMS 1500||MSA|
|Workers' Compensation Plan (Federal Employee)||NO||DD7/DD7A||NO||DD7/DD7A||MSA|
|Workers' Compensation Plan (DoD Employee)||NO||N/A||NO||N/A||N/A|
|Income (Wage) Supplement||NO||N/A||NO||N/A||N/A|
|Other/Special Coverage Group||YES||837I/UB-04||YES||837P/CMS 1500||TPC, MSA, MAC|
|None (Pay patient)||YES||Invoice and receipt||YES||Invoice and receipt||TPC,MAC|