Coding
99211 is example of what type of code?
CPT/Procedure Code
The member receiving services. (going to the dr)
When a patient is admitted into the hospital, what claim type is this?
Inpatient Claim
If a claim has a generic rejection code, the most common one we see is?
R00000
What is your primary source of research while looking into why a claim processed the way it did?
AACI claims chat bot
F42.1 is an example of what type of code?
Diagnosis
This document is sent to the member after their claim has been finalized?
EOB
A claim for services that are rendered at a facility but don't require overnight stays are considered?
Outpatient Claim (services)
If a claim denies as RERISS, this means?
We have not received the information we requested within the 45 day time frame.
In this system you can enter the denial code and prompt what the next steps are for the code?
Spark for KM
0450 is an example of this type of code..
Facility Based (Revenue Code)
If a provider does not want to personally submit their claims, they can use one of these.
Clearinghouse
This type of form is used for professional services being billed?
CMS 1500
A PMG denial stating the provider must submit the claim to the medical group has an action code of?
R50110 (R50220)
If a claim denied for not a covered benefit-what is the first thing you would research in SC?
If the member has the benefits either through the chat bot or Benefits and Cost task.
If a member has services rendered by 2 surgeons on the same day, one of the surgeons has to submit their claim with this type of code to ensure they get paid?
Modifier
This supporting documentation can be provided if a claim is pending for more information to determine medical necessity?
Medical Records
This type of form is used for facility services being billed?
UB04
What is the correct step for the provider to take on a claim that is denied with RPAIM0 denial?
Send authorization or medical records to Carelon MBM (AIM)
If a provider is not in our system, causing a claim to reject, what form could we send the provider to get loaded into our system?
W-9
Preventive DX codes always start with this letter?
Z
If a member doesn't agree with the processing of their claim, what step can be taken?
Appeal
Regardless of the type of plan a member has, Anthem is always responsible for these types of services- unless the plan has a carve out?
Mental Health
Which option do you select from the members claim details do you need to select to find more information if the claim has the action code RDELES?
Claim Text box
If the claim has been processing for more than 30 days, what steps should be taken?
Reach out to the OE chat for assistance.