Insurance & Claims Processing
This document confirms how much the insurance paid, denied, or adjusted
what is EOB?
BCBS FEP does not take this loaction
What is POS 03?
This code is used for treatment planning
what is 97151?
The crosswalk for 97153
What is Code H2019?
This is the amount a patient must pay for health services before their insurance begins to pay.
What is a deductible?
a process where the insurance company must approve a treatment plan before services can be provided.
what is Authorization?
Billing for a higher-level service than was provided — considered fraud
what is upcoding?
This is the modifier for MOLINA-S5111
what is HO (BCBA)?
Services provided by a paraprofessional (BT)
What is HM?
Carc code/adjustment code- 3
What is PR: Co-payment Amount ?
This term refers to the amount a provider agrees to write off due to a payer’s contracted rate.
what is contractual adjustment?
Carc code/adjustment code-16
what is Missing or Invalid Data?
The code for "Family adaptive behavior treatment guidance"
What is 97156/S5111?
This document is typically required before billing a secondary insurance?
What is the Primary EOB (Explanation of Benefits)?
This is the portion of the medical bill that the patient must pay out-of-pocket, often due at the time of service.
What is a copay?
True or False: All insurance payers follow the same ABA billing rules.
What is False?
Tri-west must have this on the claim
what is the time?
This modifier might be required when billing 97156 in some states or plans?
What is Modifier HO?
Modifier Used for Telehealth
what is 95/GT?
a service that is included under a persons insurance plan.
what is a covered benefit?
Name one common reason ABA claims are denied
Missing authorization or incorrect CPT code.
The same service billed more than once for the same date or session
what is a duplicate claim?
LA CARE Modifier for H0032 BCBA
what is HP?
for Cencal as a QAS provider this modifier is used
what is No Modifer?
needs to determine which payer is primary or secondary
What is Coordination of Benefits