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Professional Provider Claim Summary Enhancement

September 7, 2012 

Effective Sept. 10, 2012, the type of service (TS**) field on the professional Provider Claim Summary (PCS) will be replaced with a reimbursement payment type (PAY) field. There will be a 3-digit value listed for each service line to indicate the reimbursement rate that was applied in relationship to the member’s policy type. A list of values and descriptions will be available in the Billing and Reimbursement section of the Provider Manual.

Note: This change also applies to the Electronic Payment Summary (EPS); however, the Electronic Remittance Advice (ERA) is not impacted.