Insurance
If an insurance card is not in the registration, where can it possibly be located?
What is patient Chart
If a Claim denies for no active coverage, should this be transferred to the PE work Que?
No, you must determine the active coverage and bill correctly
With Cigna Coverage what is the time file?
90 days
What code is used for a B7 denial stating provider is not Eligible for payment on DOS?
The correct code is 3011.
Who is the Supervisor for Lela Mcneely?
Rajean Baker
Where can you look to find the address to bill a patient's insurance?
On the back of the Insurance card
If a claim is in the no response work que do you assume it is because the provider is not in network?
No, you may need to make phone calls to determine if the coverage is active, if the claim was received, etc..
What is time file for Aetna?
120 days
When the provider has dropped the charge or added an additional line item to the claim and this has resulted in past time file denial what is the write off code?
The write off code would be 3076
Who is the supervisor for Michele Turley?
Sandy Bittner
If a patient has coverage on 3/1/25 does that mean that same coverage is active on 4/1/25?
No, you must verify
If a claim denies stating Incomplete invalid prior Insurance Carrier EOB, should this claim be routed to Provider Enrollment?
No, verify who primary is, has primary paid and follow up per SOP
What is time file for Humana?
90 days is the time allowed
If a claim denies as the coverage was not active on the date of service, and has caused a time file, what is the write off code?
The correct code would be 7048
Who goes by the name of Mickey?
Michele Zompero
How do you determine if insurance coverage is active?
Use RTE, Portal, or make a call
If a claim denies for a 96, Non coverage charge should you send this denial to Provider Enrollment?
No, you must determine first why it is a non-covered charge.
Does Medical Mutual allow 365 days to file a claim before it denies for time file?
Yes, you are allowed 365 days from the date of service.
What code is used to write off balances under $9.99?
The small balance write off code is 3005
Who has stated that Old Folks sometimes call me Gracie?
Grace Handley
If you cannot determine Patient Eligibility, what do you do?
Call the Coverage and Verify Coverage
If a claim denies stating that a provider is out of network is there an SOP that tells us the steps that need to be taken to before we send the claim to the Provider Enrollment?
Yes, you can find this information in SOP 2488
For Medicare what is the time file limit?
The time file limit for Medicare is one year from date of service
When a claim denies for a 97 bundling not separately payable what is the write off code?
The correct code would be 3028
Who's favorite animal is known as the Giraffe?
Shalonda Smith