EOR
Claimant stayed at a hospital for less than 24 hrs.
What is TOB 131?
Contains one or many errors found before the claim is processed
What is a rejected claim?
National form used by professional providers to identify services that were rendered
What is CMS-1500?
This bill is undergoing the processing stage within Smart Advisor
What is a Pending/Processing Bills
The only two reasons to route to an adjuster
What is Bill denied by adjuster / Check info other than check number & issue date?
POS for an emergency visit
What is POS 23?
These claims may violate the terms of the payer-patient contract or they may just contain some sort of vital error that was only caught after being processed by the payer and is deemed un-payable
What is a denied claim?
National form used by hospitals to identify services that were rendered
What is UB-04?
This bill has a recommended allowance displayed at $0.00
What is a denied bill?
Process to open images on sites other than AmTrust.
What is CTRL+O?
POS for an Ambulatory Surgical Center
What is POS 24?
This is how a FAIRPAY bill should be hanlded
What is refer to FAIRPAY?
These codes are used to diagnose and document medical conditions
What is ICD?
This bill has at least one line displayed at $0.00
What is a partial denial?
A two-character alpha-numeric code used by the AMA to modify the description of a CPT code
What is a modifier?
Range of CPT codes for ER visits
What is 99281-99285?
CA has this requirement for appeals/reconsiderations
What is an SBR/DWC?
These codes are used to identify the services rendered by a professional provider
What are CPT codes?
This bill was submitted more than once
What is a "duplicate" bill?
Each procedure is assignes an allowance based on a percentile for all reported expensed submitted for the same procedure within the ZIP Code area
What is UCR?
First digit of the bill type code
What is facility type?
Steps to follow if a bill is not on file
What is to ask for mailing address/fax number, date it was sent & ask to resubmit
These codes refer to medical products and/or medical devices, not to be confused with type of treatment or procedure
What is HCPCS?
These bills are usually referred to as "ANY PROVIDER", M.I.A or DUMMY Provider bills
What is a "sendback" bill?
These are the components of a bill ID
What is Site code, Client code & Bill number?