Insurance & Claims Processing
his is the maximum amount an insurance will pay for services in a year.
what is annual benefit cap or maximum?
Max amount of units fir 97151?
What is 8units?
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?
This is required before ABA treatment can begin under most insurance plans.
what is Authorization?
BCBS FEP does not take this loaction
What is POS 03?
This is the modifier for MOLINA-S5111
what is HO (BCBA)?
True or False: You should wait to receive the EOB from the primary payer before submitting to the secondary.
What is TRUE?
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?
max amount of units for 97153
what is 32 units?
PHP IS BILLED UNDER THIS ENTITY
What is AIP?
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?
can be filled if heath care professional or patient feels claim is wrongfully denied
What is an appeal?
Billing for more hours than were actually delivered is known as this.
what is Fraud?
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?
The same service billed more than once for the same date or session
what is a duplicate claim?
Carc code/adjustment code-16
what is Missing or Invalid Data?
Cencal as a QAS PROVIDER we use this modifier
what is No modifier?
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