EOB
Denial Reason
Job Aid
Process
Payor Portal
100
Where do you find the EOB's for your denials?
What is Epic Liability Bucket?
What is Payor Portals for BCBS and SWHP?
What OnBase Combined Query?
100
Denial reason when you see this remark or adjustment reason codes:
What is Medical Records?
100
Aoes worklist, pending days and Midas appeal status
What is Aeos and Midas Workflow Process located in Appeal Writer's Sharepoint under Important Files and Links?
100
Midas Log In
What is BSWConnect - Midas Event?
100
Payor form is required to upload appeal on payor portal
What is SWHP/FirstCare/RightCare?
200
Denied procedure and denial reason on this EOB:
What is No authorization denial for HCPC Q9967 and CPT 71260?
200
Pre-certification/authorization exceeded denial
What is identifying what is authorized?
200
Payor Portal Job Aid Locations
What is Appeal writer's Sharepoint under Job Aids & Process Guidelines?
What is DRC L-Drive->Appeal Pending Insurance Upload Packets?
200
The process for Procedure or diagnosis inconsistent with modified/required modifier missing. HIM reviewed case before sending to DRC.
What is sending an email to HIM for secondary review?
200
Midas and Aeos status when unable to upload to payor portal (someone uploading for you)
What is Retro-Pending 1st level appeal?
What is leave it to DRC Appeal Writer worklist?
300
Incompatible revenue codes approved versus billed
(EOB inpatient denial for billed revenue code different from approved revenue code)
What is level of care denial?
300
Claim denied because previous stay was within 30 days of admission
What is re-admission?
300
Location of medical records request template
What is Appeal Writers' Sharepoint --> Template
300
Account assigned in error or duplicate account in Prod Tool
What is reach to supervisor to delete or re-assign?
300
Midas and Aeos status after uploading appeals to payor portal
What is Retro-Pending?
What is DRC Follow-Up Worklist?
400
Denial type and code denied for this EOB:
What is MUE denial for CPT 15275
151 - Payment adjusted because the payer deems the information submitted does not support this many/frequency of services
400
Approved NPI is different from billed NPI
What is calling payor to update NPI on authorization and request for re-process?
400
Summary of monthly process updates
What is Appeal Writers Sharepoint --> Monthly Summary
400
user for AA-Consult time in productivity
What is a consultee only?
400
Scott & White Payor with all number claim numbers
What is RightCare and FirstCare?
500
UB and EOB does not match total bill
What is missing EOB?
What is a split claim?
500
Denial is confusing or unclear
What is calling the payor for clarification?
500
Template for payor denied no authorization but obtained an authorization
What is using the Authorization Denial Auth Approved Template from the Appeal Writers' Sharepoint?
500
Details in verifying an account with multiple encounters in Midas
What is checking the following:
- Date of service
- encounter type
- facility
- Notes listed under Tracer field stating to search correct encounter by searching the patient's name
500
Payor states appeal not received when appeal was uploaded in portal
What is check the payor portal on status of initial submission?