A/R and UB04
The black and white version of the UB04 form is typically used for this...
What is the "Appeals Process"?
Whenever requesting a corrected claim, always include this in your note...
What is the "DCN #"?
You can confirm the plan code is correct by reviewing this...
What is "Eligibility"?
This code is placed on an account for reasons like, identifying accounts with payer issues, tracking trends and escalations...
What is a "UFC code"?
A fixed amount for each day that the patient is "In-House"...
What is "Per Diem"?
Type of Bill 111 indicates this...
What is an "hospital, in-patient, admit thru discharge"?
Partial Auth, insurance terming mid stay and end of year billing are all instances where we may need to do this...
What is "split a claim"?
The ARA must obtain these three things for appeals submission...
What is "appeals mailing address; timely filing guidelines and if any form are required"?
UFC's can be added removed or edited from here in OHPAC...
What is the "RG Actions button"?
Medicare and Medicare Advantage plans use this to determine the reimbursement rate...
What is the "CMG"?
To pull/view a UB04, go here in OHPAC...
What is the "DM View" link?
When requesting a rebill for aa corrected claim, add a coded comment with "Follow-Up" as the category and this as the Comment Code...
What is "Rebill Request"?
Any additional documents needed that are not actively available in PowerChart/DM View need to be scanned in utilizing this...
What is "DM Capture"?
This is used when an account needs additional assistance from the facility, or to notify the facility of any account issue that could have a high financial impact...
What is the "Action Items Log"?
This tool is used to view the current contracted rate for all contracted insurances...
What is the "Contract Grid Tool"?
The UB04 claim form also goes by this name...
What is the "CMS-1450 form"?
If a claim needs to be amended (changed) by a Biller, this step is requied...
What is "placing the claim on "Relay Hold"?
An appeal for short payment or no payment would be considered this type of an appeal...
What is a "Contract/Agreement Appeal "?
Use this Level 2 UFC code when there is a contract issue resulting in a short pay...
What is "CIRU"?
When using the Contract Grid Tool to view the expected rate of pay, and multiple lines are shown, you should check this always...
What is the "Rate Effective Date"?
The DCN or Document Control Number is also know as this...
What is the "Claim Number"?
Itemized statements, medical records, letters of exhaust are all examples of documents that may be required for the rebill need to be uploaded here...
What is the "Rebill Attachment request portal"?
When an insurance fully or partially recoups a payment after we submit a refund for the overpayment, we would submit this type or appeal...
What is "Refund/Recoupment"?
Use this level 3 UFC code when follow up from the facility is needed...
What is "FUND"?
Percentage based payments are always based on one of these two factors...
What is "% of CMG or % of Billed Charges"?