Denial Types
These denials usually occur when a claim denied due to documentation requested by the payor not being received by the provider.
Medical Records Denials
What can be done in Work-Queue Tab
This is where you can adjust your columns and sort/filter for specific payors, denials, etc.
This specific section in Epic will show the date the specimen was collected.
Specimen Inquiry
Name the Letter used for Contracted and Non-contracted TriCare payors
ES PB Tricare Appeal
Name the two main work instructions used within the CG Denials Workflow.
Screening (CG & CG Plus) Work Instructions
Release of Information (ROI)Work Instructions
These denials usually point to an issue with the same service or like service being billed more times or sooner than allowed within a patient specific medical policy.
Frequency Denials
Name the Section in Epic that will provide the "Contracting Status"
Reimbursement Section within the Summary Tab
True or False
CG is not a Preventative Test
False
Most insurances consider CG & CG Plus a ‘preventative’ service vs a diagnostic test.
Name the Letter used when Claim was submitted within the timely filing limit.
ES PB Non-Con Timely Appeal
This Tip Sheet walks to through the steps of reviewing an account thoroughly.
Account Review Tip sheet
Eligibility-related denials usually point to issues with insurance coverage validation at the time of service.
COB/Eligibility Denials
If a document contains multiple patients, where would you review the document.
OnBase/Unity Client
True or False
For CG/CG+ The date in Specimen Inquiry is also the DOS
True
Name the Letter used for Contracted Med Adv Payors
ES PB Denial-Contracted Med Adv w/WOL
These two work instructions will assist in the processing of Correspondence.
These denials usually point to an issue with the coding placed on the claim form. This can include CPT Code, DX Codes and/or the two in accordance.
Coding Denials
What should we review on the Story Board
If patient is 65+: Check Medicare Eligibility
Make note of Account Balance
Make note of Visit Coverages
Make note of Correspondence
Financial Assistance (Follow Normal Workflows
Name the CG Billing Identifiers
Tax ID, NPI, CPT Codes, Lab Locations
Name the Letter use when Patient is 45-49 on the DOS
ES PB 45-49 Contracted Payer Appeal
This resource will give you a break down of all our products provides CPT, Test Description, Costs etc.
General Information about ESL Products
These denials usually occur when a claim denied because a lack of obtaining prior auth and/or DOS are outside of prior auth dates.
Prior Authorization Denials
Under which Tab in Epic can you locate the Charge Line
Prof TX Inquiry Tab
Name the CG Parameters
Frequency, Age and DX Codes
Name the Letter used when a payor denies for a Medicare Remit, but the patient is only enrolled in Part A DOS
ES PB Medicare Part A Denial Request Response
This List houses any and all Payor Specific Appeal Forms
Matrix Suppression List