Wiki indian health services

[coder1]

Good Morning Coding world,

My provider seen a patient that states they were covered by indian health services. Do anyone have any information regarding this payor and its process to submit a claim for reimbursement. We provided the service at a nursing home.


Thanks

 

[wannabecoder]

Good Morning Coding world,

My provider seen a patient that states they were covered by indian health services. Do anyone have any information regarding this payor and its process to submit a claim for reimbursement. We provided the service at a nursing home.


Thanks

Have you called Indian Health directly for assistance? As far as I know you submit a claim the same on a CMS 1500 and use the correct POS etc. Is there something else that is missing?

 

[npricercm]

Indian health services

Good Morning Coding world,

My provider seen a patient that states they were covered by indian health services. Do anyone have any information regarding this payor and its process to submit a claim for reimbursement. We provided the service at a nursing home.


Thanks

Indian health is the payor of last resort. When I worked indian health, we had to call Indian Health and ask for an authorization/ PO number to treat the member.

 

[coder1]

Thank you

 

[atmacias]

Indian Health Services

Hello...with Indian Health Services a referral needs to be obtained by the patient to be be seen by your physician or facility. Once a referral is on file, you must submit your claim to the specific unit that issued that referral on a CMS-1500 form requesting a Purchase Order (PO) for payment. It is reviewed by the IHS Dept and a Purchase Order # is issued. This would then be placed in box 23. Prior Authorization Number on the CMS-1500 form. Depending on the servicing unit for the specific IHS, it would then be filed to a Fiscal Intermediary Payor or to the IHS Dept themselves for payment. And, yes, Indian Health Services is of last resort. Hope that helps