Coordinate This
This is the term used to indicate the order of the first payer in a coordination of benefits situation
What is Primary?
Current Procedural Terminology, 4th Edition
What is CPT-4?
What is the Line Item Details tab?
Pended, Awaiting Batch
What is Status 11?
What is Capitation?
This is the term used to indicate the order in which multiple payers consider claims in a coordination of benefits situation
What is Order of Benefits?
What is HCPCS?
Displays information such as member name, gender and ID#, as well as the servicing provider details (Facets ID#, TIN# and NPI#)
Pending, with Errors
What is Status 15?
This reimbursement methodology will generate a payment to the provider for the services billed
What is Fee for Service?
What is the Secondary Payer?
International Classification of Diseases, 10th Revision
What is ICD-10?
This tab shows key payment details, such as the paper check #, Payment Reference ID# for EFT payments, and paid date.
What is the Remittance Tab?
Adjusted, Processed
What is Status 91?
This is the amount of money CareSource agrees to pay a provider to render services they do not normally provide
What is a Negotiated Rate?
If you're not first or second, you're this in a COB situation
What is Tertiary?
This is the form used by medical and ancillary providers to bill insurance companies for services rendered
What is the HCFA 1500 form?
This important tab shows documentation specific to how or why a claim was processed, why a claim was adjusted, or other important details
What is the Notes tab
Closed
What is Status 99?
This payment methodology is used to establish a negotiated rate with a Non-Par provider (in rare cases, Par providers) to render a one-time service
What is a Single Case Agreement?
COB claims for most lines of business use this processing logic when considering claims as Secondary
What is Lesser of Logic?
Hospitals and other Institutional providers use this claim form when submitting claims to insurance carriers for consideration
What is the UB04 claim form?
This tab shows the Agreement ID, Pricing section and Rule applied to line-level payment, and the rate applied to a specific claim line
Accepted, Batch Complete
What is Status 02?
Par providers reimbursement is based off of what pricing list?
What is a Fee Schedule?