Medicare Advantage Claim Information

• Rural Health Clinic Billing Tips – Sterling makes these tips available on its website to promote expedited claims processing and to minimize returning claims to providers. Sterling Medicare Advantage plans process and pay claims according to Medicare guidelines, so along with these billing tips, providers should utilize standard reference manuals employed by Medicare’s contractors as billing resources. To read Sterling’s Rural Health Clinic Billing Tips, click on the link below.
• Sterling’s Rural Health Clinic Billing Tips – [https://secure.sterlingplans.com/providers/option1/billingtips_provider.html#fqhc]

• Reimbursement - Sterling reimburses Medicare approved Rural Health Clinics (RHC) on the basis of the all-inclusive rate for covered RHC services as outlined in publication 100-4, chapter 9, section 20 of the online CMS manual system. To see Sterling’s payment methodology specific to RHCs, along with bad debt and cost settlement information, please click on the link below.
• Rural Health Clinic Reimbursement Schedule – [http://secure.sterlingplans.com/providers/option1/paymentrates_manual.html#rural]

• Preventive Benefit Billing Tips – Sterling Medicare Advantage plans offer additional preventive wellness benefits, beyond what Original Medicare covers. Since these benefits are not addressed in the standard reference manuals used by Medicare’s contractors, Sterling created the following preventive benefit billing tips for providers’ reference.
• Sterling Option I® Preventive Billing Tips – [https://secure.sterlingplans.com/providers/option1/tips_preventive.html]
• Sterling Option II^SM Preventive Billing Tips – [http://secure.sterlingplans.com/providers/option2/tips_preventive.html]
• Sterling Option III^SM Preventive Billing Tips –[https://secure.sterlingplans.com/providers/option3/tips_preventive.html]
• Sterling Option IV^SM Preventive Billing Tips –[https://secure.sterlingplans.com/providers/option4/tips_preventive.html]

• Appeal Information – In the event a provider disagrees with Sterling’s claim determination, they have the right to appeal. For details on Sterling’s appeal process, click on the following link.
• Sterling Corrected Claim and Appeal Information – [https://secure.sterlingplans.com/providers/option1/appeals.html]