What does OTAF stand for in medical billing?
May 20, 2018 · Obligated to Accept Field (OTAF) This is the amount the provider agreed to accept from the primary payer when the amount is less than the charges but higher than the payment amount; then a Medicare secondary payment is due to the provider. There is not a specific column or area on an Explanaiton of Benefit (EOB) that indicates the OTAF amount.
What is OTAF 44?
OTAF - Obligated to Accept in Full (Medicare claim law) | AcronymFinder What does OTAF stand for? OTAF stands for Obligated to Accept in Full (Medicare claim law) Suggest new definition This definition appears rarely and is found in the following Acronym Finder categories: Military and Government Business, finance, etc.
What is the OTAF amount on an EOB?
Feb 01, 2019 · Value code 44 is defined as the amount a provider agreed to accept from a primary insurer as payment in full. You may also see this referred to as "Obligated to Accept as Payment in Full, or OTAF. Value code 44 should be submitted on MSP claims when the amount the provider agreed to accept is: Less than the charges; and
What is an OTAF adjustment?
(MSP) Claims when There is More than One Primary Payer— An OTAF adjustment (also see the Medicare Secondary Payment Manual) is made when a provider, physician or supplier agrees as result of negotiation or otherwise to receive a payment rate that is higher or lower than a payer’s normal allowed amount as payment in full for particular services or supplies. By regulation, if a primary payer’s OTAF amount is lower than the charge for the related service that appears on the claim, Medicare must include the OTAF adjustment when calculating the amount of Medicare’s secondary payment.
What is a demonstration project in Medicare?
paper submission—By their nature, demonstration projects test something not previously done, such as coverage of a new service. As a result of the novelty, the code set that applies to the new service may not have been included as an accepted code set in the claim implementation guide(s) adopted as HIPAA standards. The HIPAA regulation itself makes provisions for demonstrations to occur that could involve use of alternate standards. In the event a Medicare demonstration project begins that requires some type of data not supported by the existing claim formats adopted under HIPAA, Medicare could mandate that the claims for that demonstration be submitted on paper. In the event demonstration data can be supported by an adopted HIPAA format, Medicare will not require use of paper claims for a demonstration project. Demonstrations typically involve a limited number of providers and limited geographic areas. Providers that submit both demonstration and regular claims to Medicare may be directed to submit demonstration claims on paper. Non-demonstration claims must continue to be submitted electronically, unless another exception or waiver condition applies to the provider.
