Professional Basics
Procedure code not found
BPC
Non-par lab pricing
NPL
Zero allowance found on claim
ALZ
Interim billing adjustment needed
INT
Bill types 111, 112 and have a case allowance
Inpatient Claim
Duplicate claim
DUP
Claim is returned from MARS with pricing determinations/instructions
NRR
Ambulance must be priced per line
AMB
Device intensive pricing review
ISU
Pricing Method/Rule 20/012/028
Per diem
Other insurance carrier information needed
EOB
Provider is mismatch and it MUST match
PBE
Claim submitted on wrong form, should be CMS-1500
CMS
Provider under review only
PBR
System used to house claims
POWER
ITS
PCR
DRG 998/999 triggers routing
DRG
Unknown EX code returned
PEX
15-digit number that is created when a claim is entered into the system. BlueCard starts with "520"
SCCF number
NPI
NOC code under review
U99
Gamma knife procedure review
GAM
PPM timeout reprocess
PPM
System used to price our claims. You look up the claim in this system using the SCCF number
What is 'PPM'