How to Recall
A recall can only be done on this type of claim.
What is rejected.
When a Claims inquiry requires a CSD callback, the Claims inquiry associate sends an email to this email box.
What is ClaimsCallbacks
Make sure to override with a C in basic and a C in Major Medical when bypassing this logic
What is duplicate logic
This process is used to research inquiries
What is the 3R process
When recalling a claim that previously denied 959 duplicate, this rejection code should be used in i- claims to make the claim suspend.
What is 9YY
If the entire claim needs to be recalled, the recall tab on this subtab must be selected.
What is Claim subtab.
This information must be included in the subject line of your claims callback email.
What is Inq #, Last name of the CSRs manager
Claims with this rejection can never be recalled unless permission given by Network Integrity department
What is 9XT
This screen is the history table of an adjudicated claim and is used to determine if a claim is hitting an IOPS table and rejecting correctly.
What is HTBL
When a newborn is not on a contract the claim rejects 901, the system will automatically recycle the claim nightly but purges after this many days. (Hint: ARC File)
Claims automatically recalled by the system process through this file.
What is the arc file
CSR attempts this number of callback attempts
What is 1.
This suspense needs a + override if the claim should reject and if not remove the rejection from the adjudication code and MM action code and route appropriately or override appropriately to change the condition of the claim to let the system know it needs to pay
What is 379.
Claims adjudicate with this rejection when per benefits another company handles the benefits for this service and claim needs to be filed to that other company
What is 9IX
I am a paid claim and not eligible for recall, this adjudication code represents a paid claim on navigator.
What is a 960.
This should always be checked before recalling a claim to make sure claim is not already paid under another claim number.
What is claims history
Inquiries requiring ClaimsCallback should not be closed until this takes place.
What is Customer Service representative documents/ responds back stating that callback has been made
This can be accessed to see what actions where taken in order to get the claim to adjudicate.
What is audit trail
9BP, 9BQ, 9BO are all rejections that indicate fragmented coding or bundling, for review or reconsideration of lines with a bundling rejections the inquiry must be rerouted to bundling with this route code.
What is ZW
When adding a route code to a claim in suspense go ahead and use the W override to prevent this suspense the next day
What is 297
If this report is being sent a claims callback is not necessary.
What is claims report.
For a claim to process under this type of rider it must meet the following criteria; PMD contract, PMD service, and PMD provider.
What is PMD
An inquiry where multiple claims were recalled cannot be closed until this happens to all claims
What is adjudicated.