Collection notes
Bill Types
Cheat Sheet
Bill Type/Provider email
Misc
100

4th attempt. Collection efforts exhausted

Write Off

100

Collected Date and Amount Collected have value. Provider Payment Details available

PAID

100

BILL INELIGBLE FOR EXPORT

MIA

100

Claim: WC868-D08621

Patient Name: Juvencio Ibarra Alcaraz

TIN: 470975781

Provider name: Active Performance Physical Therapy

DOS: 4/26/2021

Paid

Payment details email

100

Provider request EOB for DOS 6/14/2018. Who provides the EOB?

ACCOUNTING

200

DOS has been rebilled to the carrier. Please allow 45-60 days

Within TAT

200

Age of AR is <60 days. No collected date or amt collected

WITHIN TAT

200

List the 4 criteria for Fully Outstanding

  • No value in Amount Collected column
  • No Payments are present within the Bill
  • Age of AR is more than 60 calendar days (outside of TAT)
  • AND there are NO Collection Notes indicating that the DOS are being actively worked
200

Claim: 4035365

Patient Name: Deborah Lewis

TIN: 920189705

Provider name: Westlake Sports Therapy Inc

DOS: 3/30/2021

WITHIN TAT


STILL PROCESSING EMAIL

200

List the 4 Leased Networks

Multiplan

Stratose

Optum

Magnacare

300

Provider paid correctly per day rate/fee schedule

PAID

300

Collected Date is 1/1/2021, No amount collected, Payable is $0 in billing box

WRITE OFF

300

Reject Bill Acknowledgement

INVALID RTP

300

Claim: 7151804

Patient Name: Stephanie Smith

TIN: 593747797

Provider name: Advanced Physical Therapy of Lake Co

DOS: 2/22/2021

FOAR


CREATING A PIL

300

Received an email from Gallagher Bassett. Who does this email get forwarded to?

LEIGH MILLIGAN

CIARA WARD

400

Outreach has been made to the carrier/adj

Actively being worked

30 calendar days

400

Age of AR >60 days. All lines priced. No active collection note

FULLY OUTSTANDING/ FOAR

400

DCN is less than a year

MIA

400

Claim: 005683003343WC01

Patient Name: Paul Garnet

TIN: 208666329

Provider name: Atwood, Amanda

DOS: 8/31/2020

MIA


CREATING A PIL

400

TRUE OR FALSE?

For Wrap Rate providers, if one cpt code bills at $0, this is considered MIA

TRUE

500

Claim denied by adjuster as not a work related injury

DENIED

500

Payment paid to incorrect provider

REFUND REQUEST

500

Claim denied for a valid reason but provider is challenging it

Suggest the appeal process

500

Claim:  301938015090001

Patient Name:  Jose Gomez

TIN: 592355972

Provider name:  Physicians Health Center

DOS: 11/4/2019

VALID RTP


EMPLOYER CARVE OUT TEMPLATE

500

TRUE OR FALSE


MEDRISK CAN PROCESS PARTIAL PAY LOGS FOR MULTIPLAN PROVIDERS

FALSE

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