Contacts (WHO?)
This identifies the person or organization you spoke with.
What is the payer name?
This action needs taken before using the ACC status code.
What is taking an adjustment
This is where claim status is often verified electronically.
What is a payer portal?
This tells the next person when the account should be reviewed.
What is the follow-up date?
This explains why you entered the account.
What is the reason the account was worked?
This should be documented when speaking with an insurance representative.
What is the representative's name?
This should be documented after checking claim status online.
What is the claim status?
Availity is an example of this.
What is a portal?
This should be documented after submitting an appeal.
When should the appeal be followed up on?
This should explain why the payer was contacted.
What is the purpose of the call?
This tells future users which area of the payer was contacted.
What is the department name?
This explains why a claim was not paid.
What is the denial reason?
This should be documented when information comes from an insurance website.
What is the website or system used?
This indicates how long a claim should be allowed to process.
What is the follow-up timeframe?
This should explain why eligibility was reviewed.
What is the reason for verification?
This contact information should be included when available.
What is the phone number?
These should be documented when submitted to a payer.
What are medical records or supporting documents?
This tells future users where information was obtained.
What is the source of the information?
This helps prevent accounts from sitting untouched.
What is the next action date?
This tells future users why records were submitted.
What is the purpose of sending the records?
These details fully identify who provided the information.
What are the representative's name, department, title, and phone number?
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What is the delimiter bar
These should be documented when multiple systems are used.
What are all portals, websites, and resources used?
This should always be documented if more work is needed.
What is the specific follow-up date?
This should explain the overall reason for all account activity.
What is the business reason for working the account?