A
When a claim is denied for coverage not active. What should you checked?
Check Eligibility
Claim is ready to be released to payer?
Ready to Submit
Has both in and out of network benefits?
PPO
Inpatient Benefits, which is related to facility fees for Medicare
Medicare Part A
Meaning of PCP?
Primary Care Physician
Reason Code 2
Coinsurance Amount
Expenses incurred to prior coverage. What is the reason code?
Reason Code 26
What is the reason code for the timely filing has expired?
Reason Code 29
Is reason code 105 a denial or not?
Not a denial
What is 99213?
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and a low level of medical decision making.
How many days does it take for the timely filling to be submitted?
90 days grace period
Where is the PMDS located?
8051 E Maplewood Ave Ste 160, Greenwood Village, CO 80111, United States
Amount patient must pay before insurance will cover any expenses
Deductible
What is reason code 54?
Multiple physicians/assistants are not covered in this case.
Difference between PPO and HMO?
Has both in and out of network benefits.
Usually has no out of network benefits.
If patient has Medicare as primary but was billed to the secondary insurance. What should you do?
Bill it to the secondary insurance.
If claim was denied as timely filing but within timely filing.
Dispute the claim since it is within timely filing.
If the procedure was denied as non-covered but it is part of the benefits, what should be the next step?
File an appeal with medical records
If there is no authorization for Injection and you found one, what should you do?
Dispute the claim since we have authorization for the claim?
If the patient has no insurance. What would be the step?
Bill it to the patient. Drop Balance to patient.