PRICING
YOU HAVE RECEIVED AN AUDIT AND NEED PRICING RE-VALIDATED, WHAT IS THE APPROPRIATE SUBJECT LINE ON THE EMAIL?
WHAT IS QRP, CLAIM NUMBER.....?
IS THE COLONOSCOPY COPAY A SOP OR JOB AID?
WHAT IS A JOB AID?
YOU HAVE A mEV EDIT AND THE E/M CODE BILLED ON THE HISTORY CLAIM DOES NOT HAVE A 25 MODIFIER WHILE YOUR CLAIM IS BILLED WITH A 25 MODIFIER.
WHAT IS APPLY CES OVERRIDE AND NOTATE CLAIM?
YOU GET AN AUDIT YOU DONT UNDERSTAND
WHAT IS SEND QUESTION TO NEW DAY BOX and/or CC LEAD AND SUP?
IF A CLAIM IS RECEIVED WITH AN INCORRECT FREQUENCY, IS IT CLEAN OR UNCLEAN?
WHAT IS UNCLEAN?
THE HOSPITAL BILLED FOR 9 DAYS, THE AUTH IS APPROVED FOR 7. THE CLAIM HAS BEEN IN THE SYSTEM FOR 53 DAYS.
WHAT IS SEND FOR PRICING OF APPROVED 7 DAYS?
WHAT IS THE APPROPRIATE CLAIM FORM FOR HOSPITALS?
WHAT IS A UB?
YOU HAVE AN mEV EDIT AND BOTH CLAIMS ARE EXACTLY THE SAME
WHAT IS DENY SECOND SUBMISSION AS DUPLICATE?
NOTES STATE CONTRACTUAL DENIAL PER EVICORE.
WHAT IS DENY MSI?
WHERE SHOULD YOU ADD YOUR REWORK NOTE ON THE ORIGINAL OR THE NEW CLAIM?
WHERE IS THE NEW CLAIM?
WHAT NOTE IS REQUIRED FOR PRICING ON A 2021 LTCH CLAIM?
WHAT IS "LTCH CLAIM; PLEASE PRICE AS CLAIM EXCLUDED FROM SITE NEUTRAL METHODOLOGY?'
IF A CLAIM IS PAYING OR DENYING MORE THAN $25000.00 DOLLARS, WHAT DO YOU DO?
WHAT IS PEND QRP?
YOU HAVE AN mEV EDIT AND THE PROVIDER SPECIALTIES ARE NOT THE SAME. FOR EXAMPLE ONE IS AN ENDOCRINOLOGIST AND THE OTHER IS A CARDIOLOGIST.
WHAT IS APPLY CE OVERRIDE AND NOTATE. DO NOT CONTINUE WITH THE EVALUATION AND MANAGEMENT SERVICES SOP?
A NONPAR PROVIDER BILLS A 323 TOB. (NONPAR PROVIDERS ARE PAID BASED ON RUG RATES).
WHAT IS DENY TOB?
WHAT EVENT CODE DO YOU USE TO DENY AN INCARCERATED MEMBER UM CLAIM?
WHAT IS DIM?
HSS AND WEBSTRAT CANNOT PRICE AND THE MEDICARE ID HAS NOT BEEN VERIFIED WITHIN A 30 DAY TIMEFRAME.
WHAT IS SEND EMAIL FOR MEDICARE ID VERIFICTION AFTER CHECKING HMEDATA.COM?
THE AUDITORS GAVE YOU DIRECTION AND YOU NEED CLARIFICATION.
WHAT IS DO NOT ASK QUALITY AND SEND QUESTION TO NEW DAY BOX/OR SUP/LEAD?
A CLAIM IS RECIEVED ON 1/26/2021 FOR A DATE OF SERVICE OF 4/5/2019 AND A HISTORY SEARCH SHOWS THE FIRST CLAIM DENIED LBI ON 6/5/2019. THE PROVIDER IS CONTRACTED WITH UNITED AND NO OTHER CLAIMS ARE ON FILE.
WHAT IS DENY CLAIM DTF?
THE CLAIM PROCESSED WITH PR TYPE 3 TO DENY PER UM NOTES BUT YOU are unsure if it had a 319 OR 270 EVENT CODE.
WHAT IS TAKE THE CLAIM TO THE INQUIRY SCREEN, SCROLL DOWN AND SELECT THE HISTORY TAB, THEN SCROLL TO THE FAR RIGHT TO REVIEW THE EVENT CODE LIST?
YOU HAVE A FREQUENCY 1 CLAIM PENDING AS A POSSIBLE DUPLICATE, AND A FINALIZED FREQUENCY 7 IS ON FILE. WHAT IS THE CORRECT DENIAL EVENT CODE?
WHAT IS DPC?
THE UB CLAIM DOES NOT HAVE A MEDICARE ID IN THE BOX AND HAS NO PRICING.
WHAT IS RELOAD THE PROVIDER ID?
YOU NEED TO RETRACT THE CORRECTED CLAIMS LETTER SENT IN ERROR
WHAT IS ADD THE NOTATION NOTRWKUPHDD/MM/YYYY?
HSS AND WEBSTRAT CANNOT PRICE AND THE MEDICARE ID HAS BEEN VERIFIED WITHIN A 30 DAY TIMEFRAME AND DETERMINED MISSING/INVALID/CLOSED.
WHAT IS DENY UBI AND NOTATE?
THE NON PAR PROVIDER CLAIM HAS A 319 PEND AND IS SET TO PAY 78.19.
WHAT IS PROCESS CLAIM WITHOUT ROUTING FOR AUTH REVIEW SINCE THE PROVIDER IS NONPAR AND PAYING LESS THAN 500.00?
YOUR CLAIM WAS RECIEVED A MONTH BEFORE THE PROCESSED HISTORY CLAIM BUT THEY HAVE DIFFERENCES BETWEEN THE TWO CLAIMS.
WHAT IS DENY THE CLAIM 627?