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CMS Standardized Provider 2025

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The CMS Standardized Provider Inquiry Chart outlines standard inquiry categories and definitions for Medicare Administrative Contractors (MACs) to categorize and report provider inquiries related to Medicare Fee-For-Service (FFS). It details various types of inquiries, including adjustments, administrative billing issues, claim denials, eligibility, and financial information. Each category includes specific subcategories that describe the nature of the inquiries made by providers regarding claims processing, billing instructions, coverage rules, and other operational aspects of the Medicare program.

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What is a provider-based clinic in CMS?

Provider-Based or Hospital Outpatient Clinic refers to the billing process for services provided in a hospital outpatient clinic or location. This is a Medicare status for hospitals and clinics that meet specific Medicare regulations and requires that we bill Medicare in two parts (Part A and Part B).

What does CMS provider-based mean?

Are the Centers for Medicare and Medicaid Services Legitimate? Yes. The Centers for Medicare Medicaid Services (CMS) is part of the U.S. Department of Health and Human Services (HHS).

What does CMS standardized plan mean?

Standardized plan options are Qualified Health Plans (QHPs) that offer standardized cost-sharing and pre-deductible coverage at every product network type, as described in the definition of product at 45 C.F.R. 144.103, and throughout every service area in which an issuer offers non- standardized QHP options.

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